Regarding cardiac surgery activity, we are witnessing a growing trend of degenerative valvular diseases, while the rheumatic pathology has had an abrupt decline: this explains the increased prevalence of valvular disease in ageing populations. The increasing prevalence of aortic stenosis (AS) and mitral regurgitation (MR) among older age groups is supported by several empirical studies(12,13). An analysis of temporal trends from 108,687 isolated aortic valve replacements in the Society of Thoracic Surgeons (STS) database between 1997 and 2006 showed that the percentage of patients aged more than 80 increased from 13 to 20% (14). Furthermore, recent studies have confirmed that age-distribution pattern of patients undergoing cardiac surgery: in the 2018 German Report (15) the age distribution of patients demonstrated a continuous shift toward an elderly population, with 34.8% of the cardiac procedures being performed in patients from 70 to 79 years of age, and 17.6% in octo-/nonagenarians. Overall, these findings suggest that the higher prevalence of valvular disease with therapeutic indications (either surgical or interventional) occurs within and after the seventh decade of life.