Valve replacement in the elderly: Frequently indicated yet frequently denied

Background: The prevalence of aortic stenosis is nearly 20% in octogenarians. Aortic valve replacement (AVR) is the optimal therapy choice, yet many symptomatic patients are denied this beneficent technology. Whether mechanical or bioprosthetic, aortic valves are not a scarce resource and their safety, effectiveness and longevity are proven. Objective: Because the geriatric population is soaring, clinicians will be encountering more cases of aortic stenosis and the decision-making that leads to surgical referral or non-referral warrants exploration. Methods: A literature review was conducted to explore the notion that physicians deny AVR to their patients based solely on their chronological age value. Results: Using age as the sole exclusion criterion, medical literature documents the fact that AVR is frequently denied to the elderly. Conclusion: It appears that AVR is another beneficent cardiac technology that has been added to the age discrimination list, even though the devices are not scarce, they are cost-effective, and they can improve the life of a symptomatic elderly patient. There is no ethical justification for denying AVR to clinically suitable elderly candidates who request such therapy. Copyright (C) 2003 S. Karger AG, Basel.