Cardiac surgery is being offered to an ever expanding range of patients. In this regard we are victims of our own success. Cardiac surgery is now routine and as techniques and results have improved, indications have broadened. Whether it is coronary bypass surgery for young diabetic patients awaiting renal transplantation or elderly patients with disabling symptoms of aortic stenosis, a case can be made for each operation.

The problem is that we can only do so much operating with the resources available. How are we to chose between patients? The ethical dilemmas are discussed elsewhere, but from a surgeon’s standpoint, what are the issues that spring to mind when considering cardiac surgery in the elderly? …