The decision to proceed with cardiac valve surgery in patients older than 70 years must be made with careful deliberation. Clearly, the risks of surgery are increased, but the potential benefits in rehabilitating the individual back to a productive and full life are real. An aggressive surgical approach should be taken in patients with aortic stenosis. More caution should be used in advocating mitral valve or double-valve replacement in the elderly, especially when other factors place these individuals in a high-risk category. Both patients and their families should be fully aware of the potential risks and benefits in weighing their decision to proceed with surgical therapy.