Any definition of old age is arbitrary and influenced by several factors, but cultural background and national retirement policies are often dominant. The so called “elderly” are a heterogeneous population whose age span covers three decades or more. The over 65 age group in England and Wales are projected to increase by 8% for the period 1991–2031,1 but over this 40 year span the projected increase in people aged 75–84 is almost 50%. The prevalence of disability, particularly from cardiovascular disease, and multiple morbidity rises with age. More positively, chronic disability in older people has been falling over the past decade and this process is likely to continue.2

Since the middle of the 1980s developments in the surgical management of cardiovascular disease, especially for aortic valve disease, has had a dramatic impact on quality of life and prognosis at all ages. Symptomatic cardiac disease in elderly patients is often more refractory to continued medical measures than in younger adults, and surgery may be the only option to restore functional competence and quality of life.