Is it ever too late to operate on the patient with valvular heart disease?

All valvular heart disease imparts a hemodynamic burden on the left and/or right ventricle. This burden can only be removed effectively by correcting the responsible valvular lesion. Although a percutaneous approach is usually used to correct mitral stenosis, other valve lesions require surgical intervention. Over the past 40 years there has been a persistent improvement in our understanding of the pathophysiology of valvular heart disease and in the surgical techniques for correcting it. These factors have acted in concert to alter our view of the proper timing and applicability of surgery. On one hand it is no longer necessary or even advisable to delay surgery until advanced symptoms are present, and thus surgery is timed earlier today than it was even a decade ago. On the other hand, many but not all patients with far advanced disease, once considered inoperable, are now often helped substantially by valve surgery. However, selection of which of these very ill patients will or will not benefit from valve surgery remains a challenge for all of us. It is this group of patients that is addressed in the review.