Abstract
<title>Abstract</title> <p>As life expectancy increases, more octogenarians present with complex cardiac disease requiring surgical intervention. Chronological age alone should not exclude elderly patients from surgery; instead, biological age, frailty, and overall functional status should guide decision-making. We report the case of an 80-year-old man with severe three-vessel coronary artery disease, bicuspid aortic valve regurgitation, ascending aortic aneurysm, and moderate-to-severe mitral and tricuspid regurgitation. Following multidisciplinary assessment and frailty evaluation, he underwent a combined Bentall procedure, triple coronary artery bypass grafting, mitral valve repair, and tricuspid valve repair. Despite prolonged cardiopulmonary bypass and cross-clamp times, the patient had a favorable postoperative outcome, with discharge on the tenth postoperative day. This case highlights that, with careful patient selection, thorough risk stratification, and optimal perioperative management, complex cardiac surgery can be successfully performed in selected octogenarians.</p>