TAVI-specific risk predic- tion tools are also available (http://tools.acc.org/ Frailty assess- ment for at-risk patients is routine.7 11 Patients toward the higher end of the risk spectrum, for whom intervention would be futile or associated with a high likelihood of a poor outcome, should Table 8. Risk Assessment for Surgical Valve Procedures Criteria Low-Risk SAVR (Must Meet ALL Criteria in This Column) Low-Risk Surgical Mitral Valve Repair for Primary MR (Must Meet ALL Criteria in This Column) High Surgical Risk (Any 1 Criterion in This Column) Prohibitive Surgical Risk (Any 1 Criterion in This Column) STS-predicted risk of death* AND AND OR Predicted risk of death or major morbidity (all-cause) >50% at 1 y OR Frailty None AND None AND 2 Indices (moderate to severe) OR 2 Indices (moderate to severe) OR Cardiac or other major organ system compromise not to be improved postoperatively None AND None AND 1 to 2 Organ systems OR 3 Organ systems OR Procedure-specific impediment None None Possible procedure-specific impediment Severe procedure-specific impediment *Use of the STS Predicted Risk of Mortality (http://riskcalc.sts.org/stswebriskcalc/#/) to predict risk in a given institution with reasonable reliability is appropriate only if institutional outcomes are within 1 standard deviation of the STS average observed/expected mortality ratio for the procedure in question. The EUROSCORE II risk calculator may also be considered for use and is available at http://www.euroscore.org/calc.html. Seven frailty indices: Katz Activities of Daily Living (independence in feeding, bathing, dressing, transferring, toileting, and urinary continence) plus independence in ambulation (no walking aid or assistance required, or completion of a 5-m walk in <6 s). Other scoring systems can be applied to calculate no, mild, or moderate to severe frailty. 