title: Aortic valve replacement in the elderly: frequently indicated yet frequently denied.
abstract: BACKGROUND
  The prevalence of aortic stenosis is nearly 20% in octogenarians. Aortic valve replacement (AVR) is the optimal therapy choice, yet many symptomatic patients are denied this beneficent technology. Whether mechanical or bioprosthetic, aortic valves are not a scarce resource and their safety, effectiveness and longevity are proven.
  
  
  OBJECTIVE
  Because the geriatric population is soaring, clinicians will be encountering more cases of aortic stenosis and the decision-making that leads to surgical referral or non-referral warrants exploration.
  
  
  METHODS
  A literature review was conducted to explore the notion that physicians deny AVR to their patients based solely on their chronological age value.
  
  
  RESULTS
  Using age as the sole exclusion criterion, medical literature documents the fact that AVR is frequently denied to the elderly.
  
  
  CONCLUSIONS
  It appears that AVR is another beneficent cardiac technology that has been added to the age discrimination list, even though the devices are not scarce, they are cost-effective, and they can improve the life of a symptomatic elderly patient. There is no ethical justification for denying AVR to clinically suitable elderly candidates who request such therapy.
authors.affiliation: Department of Community Medicine and General Practice, Monash University, East Bentleigh, Vic., Australia. bioethics@go.com
authors.forename: Katrina A
authors.initials: KA
authors.lastname: Bramstedt
mesh_terms: D000367:Age Factors; D000368:Aged; D001021:Aortic Valve; D001024:Aortic Valve Stenosis / Q000601:surgery; D006350:Heart Valve Prosthesis; D006801:Humans; D018579:Patient Selection