Very elderly patients with severe aortic stenosis will probably benefit from percutaneous balloon valvuloplasty. Ninety-two patients, aged 80 or older (mean age, 84 +/- 3.7 years) and all severely incapacitated (18 with an associated pathologic condition or in critical condition with terminal heart failure), underwent a valvuloplasty procedure. Femoral access was used in all cases except seven (8%), in whom the femoral route had to be abandoned and the brachial approach was used due to severe arterial tortuosity. Peak-to-peak ventriculoaortic gradient decreased from 71 +/- 27 to 27 +/- 15 mm Hg, and the aortic valve area increased from 0.48 +/- 0.16 to 0.91 +/- 0.35 cm2 (p less than 0.01). Thirty-two percent had a postprocedure aortic valve area more than or equal to 1 cm2. The final valve area was less than or equal to 0.7 cm2 in 30% of the patients. There were three deaths (ages, 82, 92, and 98 years) in the procedure room. One stroke occurred 1 day after the procedure. Hematoma or thrombosis at the femoral puncture site was observed in 14 cases (15%), requiring surgical repair in only five cases. Three patients died in the hospital; the total in-hospital mortality was 6.5%. Among the 62 patients about whom information could be obtained at a mean follow-up interval of 13 +/- 5 months, there were 18 late deaths (mean age, 85 +/- 11 years). The majority of the surviving 44 patients experienced marked symptomatic improvement. The results indicate that balloon valvuloplasty can be offered to very elderly patients with severe aortic stenosis and can produce improvement in hemodynamic and clinical status.