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Major Gynaecological Surgery in Patients with Severe Coronary Artery Disease — the Combined Approach

EDITORIAL COMMENT: It is generally concluded that despite advanced age, and associated medical problems, very elderly women can usually tolerate major gynaecological surgery, after careful preoperative medical evaluation and therapy. This paper considers the particular problem presented by severe coronary artery disease, and the necessary precautions during surgery are elaborated. The decision whether or not to operate in elderly patients will depend upon how pressing is the indication (it seemed imperative in the 2 cases presented here), and how willing is the patient (how distressing are her symptoms)!—in other words the same considerations as in younger women. It is remarkable how well elderly women tolerate major gynaecological surgery as long as extra care is taken to avoid complications (blood loss, tissue trauma, infection, tight sutures in vaginal epithelium). However, in the editor's experience, coronary artery disease is the most common absolute contraindication to major gynaecological surgery in middle‐aged and elderly patients.