Too Old for What?
Thibault, George E.
New England Journal of Medicine. 1993 Apr 1; 328(13): 946-950.
...What do you do for an 87-year-old woman with this combination of diseases [aortic stenosis, serious coronary artery disease, and left ventricular failure]? Do you contemplate aortic-valve replacement and triple-vessel bypass surgery? The reason to consider heart surgery in patients of this age is not to prolong life but to improve the quality of life. This woman is apparently vigorous and had been active and independent. I think it is quite appropriate to consider aortic-valve replacement and coronary bypass surgery with the expectation that she would recover ventricular function and that the quality of her life would improve. Her operative risk would be 8 to 10 percent, or perhaps even a little higher. But I think it is a risk well worth taking. Balloon valvotomy has no role here; in fact, it has little role except perhaps as an emergency measure in an elderly patient. I would also not consider her a candidate for coronary angioplasty. So, I think it would be appropriate to recommend that she have cardiac surgery, carefully delineating the risks, including postoperative complications, so that she can make an informed decision.
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