however, do little to improve the condition of elderly patients with severe valvular heart disease, and some will remain house bound or bedfast. Moreover, domiciliary care for these patients, who may survive for a long time in chronic heart failure, is expensive.'3 The idea that cardiac surgery is an expensive luxury dies hard, but Morgan et all' have shown that a valve replacement operation costs only 5000 more than an oesophagectomy. Oesophagectomy is considered to be a necessity, and little thought is given to the cost, even though the operative mortality is high and the long-term survival negligible. The advantages of surgical valve replacement for these elderly patients include restoration to full activity, an independent existence, and freedom from dependence on an overstretched medical and social domiciliary service. Not only are the results of surgical treatment much better than those achieved by medical management but the case for valve replacement can also be justified on economic grounds. References

No abstract

No abstract

No abstract