When is heart surgery considered too high-risk to perform?

Surgery becomes prohibitive when predicted mortality is around 15% or higher, or when expected quality of life won’t improve due to other advanced illnesses.

Key prohibitive factors include:

• Severe frailty (slow gait speed, poor functional status)
• Dialysis-dependent kidney disease
• Severe lung disease requiring oxygen
• Advanced liver disease or active cancer
• Severe dementia
• Multiple prior chest surgeries with high technical risk

For these patients, transcatheter alternatives such as TAVR or MitraClip may be better options. Importantly, age alone is not a contraindication - physiologic age matters more than chronological age.