How old is too old - or are other factors more important than age?

[Cindo]

I know that the upper age limits for heart surgery have been pushed upward but wonder if age is the limiting factor or other health issues that determine who gets surgery and who doesn't. The question is about a 89 year old lady who had rheumatic fever at age nine and has had the typica mitral and aortic valve problems for a lifetime. The aortic valve is now narrowed so much that the lady has had one stroke (from which she rehabed) and is now on 40 mg lasix per day plus 3 to 5 mg coumadin depending on blood tests. She is also getting a low salt diet. Other health issues for her include: about a 10 percent blockage of right carotid artery, about 40-60 percent in left (with no problems or symptoms) and a recurring bladder infection because her bladder fails to empty entirely. The lady is otherwise active and always seems to suceed in what she attempts. For example, about 7 years ago she had a fall (nothing age related) in which an eye was so damaged that it had to be removed, and she learned to drive again on a limited basis without binocular vision. She was recommended for the more intense in-hospital rehab routine instead of the laid-back version at a nursing home often used for less energetic old folks. A number of this lady's aunts and uncles lived to 99, 104, etc., and were active until their last few months, so she seems to have the genetics and attitude to enjoy life for another decade. Is she too old for the less invasive (laproscopic?) form of valve replacement? The aortic valve is about to become critically narrow.
                       C

[CCF-M.D.-DLB]

This is a tough question. Age per se is not a limiting factor for heart surgery, though it does raise the risk of serious complications and death. We (as well as other centers that do high-risk surgery) not uncommonly operate on patients in their 80's and occasionally in their 90s. However, I would not recommend surgery on her valve unless it is causing symptoms such as severe shortness of breath that cannot be controlled with medication. The stroke will also make most surgeons very reluctant to operate, as her risk of a peri-operative stroke is higher than it would otherwise be. It may be best to have her evaluated by a place that does high-risk surgery to get a more formal answer.