[Cardiac surgery and the elderly].

Cardiac surgery continues to play a key role in our therapeutic arsenal against many heart diseases. This is still the case despite the recent and striking progress regarding specific drugs or different forms of cardiac intervention. However, in relation to the elderly patient, this therapeutic modality is one of the fields where agebased discrimination has been practiced for years, that is, the ageism referred to in the English-speaking literature. Age has been, and to a great extent continues to be, a core issue when establishing indications and contraindications in the different protocols under discussion. In this context, 3 main questions need answering. The first is to define what indications we are discussing and whether these are the same as those established for younger patients. The second is to determine surgical risk in relation to mortality and morbidity, with the understanding that comparisons should based less on age (older vs younger) and more in relation to what alternatives to surgery are available in every specific case, regardless of the patient’s age. The final question attempts to define and identify the risk factors determining a worse prognosis and, on that basis, to establish strategies to reduce this risk. The answer to the first question is easy. In the elderly, as in the young, there are 2 large areas of surgical activity: coronary surgery and valvular surgery. Coronary heart disease is strongly linked to the changes associated with the aging process and, to the extent that risk factors continue to be better understood and controlled, the age of onset has been delayed until it has become a typical geriatric pathology. In relation to valvular heart disease, within which context rheumatic heart disease has become negligible, the problems are associated with so-called degenerative aortic stenosis, which is also more frequent as age increases and, to a lesser extent, with certain forms of mitral valve regurgitation. Other types of surgical Cardiac Surgery and the Elderly