The relative prevalence of calcific degenerative valvular disease in patients undergoing surgical intervention has increased dramatically over the past several decades, in part because of longer lifespans and prevention of rheumatic fever.<sup>30 Dare A.J., Veinot J.P., Edwards W.D. , et al. New observations on the etiology of aortic valve disease: a surgical pathologic study of 236 cases from 1990 Hum Pathol 1993 ;  24 : 1330  [cross-ref]

Cliquez ici pour aller à la section Références</sup> Also, surgical intervention is increasingly used in management of valvular disease in the elderly (Table 1).<sup>2 Akins C.W., Daggett W.M., Valhakes G.J. , et al. Cardiac operations in patients 80-years-old and older Ann Thorac Surg 1997 ;  64 : 606  [cross-ref]

Cliquez ici pour aller à la section Références, 114 Shapira O.M., Kelleher R.M., Zelingher J. , et al. Prognosis and quality of life after valve surgery in patients older than 75 years Chest 1997 ;  112 : 885  [cross-ref]

Cliquez ici pour aller à la section Références</sup> Recognition of valvular disease in elderly patients is hampered by the overlap in symptom profiles between those with and without valvular disease and by the nonspecific physical examination findings in many elderly patients. Symptoms of chest pain, shortness of breath, exercise intolerance, and dizziness are common and have many other potential causes so that valve disease often is not considered in the differential diagnosis. Similarly, since systolic murmurs are so frequent in the elderly, the patient with severe aortic stenosis, but a soft murmur, may be missed.

Although it is recognized that surgical in tervention can be performed with an acceptable operative mortality and morbidity in selected elderly patients, the importance of considering comorbid conditions and functional status in surgical decision making in the elderly cannot be overemphasized.<sup>43 Fremes S.E., Goldman B.S., Ivanov J. , et al. Valvular surgery in the elderly Circulation 1989 ;  80 (suppl II) : 77

Cliquez ici pour aller à la section Références, 114 Shapira O.M., Kelleher R.M., Zelingher J. , et al. Prognosis and quality of life after valve surgery in patients older than 75 years Chest 1997 ;  112 : 885  [cross-ref]

Cliquez ici pour aller à la section Références</sup> Normal aging changes can substantially impact the ability of the elderly to tolerate cardiovascular surgery, so benefits of surgery with regard to symptom relief and improved survival must be balanced against the surgical risk, keeping in mind that surgical morbidity (e.g., cerebrovascular events) may be of even more concern than surgical mortality rates (Figure 1). Clearly, the elderly patient should be fully informed and involved at every stage of the decision-making process. Although there is increasing data to make evidence-based decisions on the elderly patient with valvular disease, there are still many areas of uncertainty. Thus, patient management remains a complex task requiring a highly individualized approach.