Heart valve disease in the elderly is mostly caused by degenerative changes, commonly mitral valve insufficiency, aortic valve calcification or insufficiency and ischemic heart disease caused by mitral valve insufficiency, etc. Only a few are chronic rheumatic valve disease. Because of the patient’s age, long onset, serious secondary lesions, or combined with other diseases such as coronary heart disease, hypertension, diabetes, and cardiopulmonary and renal impairment, the risk of surgery is higher than that of young people, and the prognosis is poorer than that of young people. However, in recent years, with the continuous improvement of surgical techniques and the advancement of anesthesia and extracorporeal circulation technology, more and more elderly patients are requesting surgical treatment to improve their quality of life, and the efficacy is getting better and better, and the surgical results are similar to those of young people, which can prolong their life and improve their quality of life. 1, aortic valve disease Aortic valve disease is one of the common heart diseases, of which aortic valve disease due to rheumatic fever heart disease accounts for the majority. Congenital heart valve developmental malformations and age-related valve degeneration or other causes such as infection, Marfan syndrome, and trauma can also cause serious aortic valve disorders. (1) Indications for surgery If the patient has symptoms such as panic, shortness of breath and restricted activity, and the transvalvular pressure difference exceeds 50 mmHg or more should be treated surgically. If there are changes in electrocardiogram and left heart insufficiency, active surgical treatment should be performed. If there is coronary artery disease, valve plus bypass surgery should be performed at the same time. Patients with aortic valve closure insufficiency should be operated as soon as symptoms appear and the disease develops rapidly, even if the heart enlarges significantly, they should also be actively operated, but the risk of surgery increases and the postoperative recovery is slow. (2) Aortic valve replacement In cases where the aortic valve cannot be repaired, aortic valve replacement should be actively considered. The size of the valve annulus is routinely measured with a valvulometer, and a suitable valve is selected according to the patient’s age and weight. Generally, elderly patients aged 65 years or older should choose more biological valves. (3) Postoperative management Postoperative management of the aortic valve requires attention to prevent hypertension and the use of intravenous nitroglycerin and sodium nitroprusside if necessary. In case of severe aortic stenosis, patients with significant myocardial hypertrophy may need to maintain a higher left atrial pressure to meet the cardiac output, otherwise as in common cardiac surgery. Prothrombin time and activity should be checked on the morning of the first postoperative day, and the patient should be started on oral Warfarin anticoagulation therapy as appropriate. The prothrombin time is usually maintained within one times the control normal time and the activity is about 30%. Patients should be reviewed regularly after discharge, rested, and given oral cardiac diuretics. Lifetime anticoagulation is required with mechanical flaps, 3 months if biological flaps are used, and no anticoagulation is required with homogeneous flaps. Surgical outcome: The surgical outcome was satisfactory. The general in-hospital mortality rate was about 2%, and all patients operated on at the First Affiliated Hospital of Tsinghua University were successful, including those with severe cardiac insufficiency and combined coronary artery disease. The quality of life of patients after surgery has improved significantly. 2, mitral valve disease The incidence of rheumatic valve disease has gradually decreased in recent years. Mitral valve damage is the most common in rheumatic valve disease, but the elderly are mostly patients with a long history, degenerative disease, mitral tendon rupture or myocardial ischemic papillary muscle insufficiency in coronary artery disease, and after myocardial infarction. Most patients can be repaired by surgical methods, and some patients need to be treated by transvalvular replacement. (1) Indications for surgery Elderly people should be treated surgically if they have obvious symptoms, normal function of other organs, no abnormalities in the hematological system, systemic condition allows, and a clear diagnosis of mitral valve lesion or thrombus in the left atrium. If there is atrial fibrillation, radiofrequency or microwave ablation treatment can be performed at the same time. (2) mitral valvuloplasty: degenerative lesions in the elderly, mitral tendon rupture or prolapse causing mitral valve closure insufficiency should be preferred. Anticoagulation is not required after valvuloplasty, and the long-term results are better than those of mechanical and biological valves. The key is to have a good surgical technique and to choose the appropriate surgical indication. The surgical approaches are divided into mitral stenosis junctional dissection and mitral valve insufficiency reconstruction. The latter includes partial resection of the posterior mitral leaflet, junctional folding and suturing, artificially formed ring suturing, and tendon transfer. (3) mitral valve replacement Generally, elderly patients choose biological valve treatment, which does not require long-term anticoagulation, mechanical valve can also be selected, but requires lifelong anticoagulation therapy. (4) Postoperative management: similar to aortic valve, artificially assisted breathing, attention to blood gas and electrolyte balance, often need to use intravenous dopamine and other positive inotropic drugs or the simultaneous application of vasodilators. (5) surgical results: long-term follow-up results show that the majority of patients can recover to class I-II cardiac function, anticoagulation-related comorbidities are 5%-10%, 10-year survival rate is about 70%, and the incidence of reoperation is 1%-5%. Combined mitral and aortic valve replacement Bivalve replacement in elderly patients is mostly due to rheumatic heart disease, and patients show symptoms such as cardiac insufficiency. The risk of surgery is increased due to the long history, heavy disease, poor general condition, or the combination of other geriatric diseases such as hypertension, diabetes and coronary heart disease, but if the condition allows, surgical treatment can achieve good results.