The editorial by Heyburn and McBrien  suggests that echocardiography before hip fracture surgery should be routine. These conclusions, if applied, have to be extended to all emergency surgical procedures in the elderly.
The potential harm with such measures has not been considered. Delays in surgery will be increased, which have been clearly shown to be detrimental in the elderly . In addition, the cost implications of providing such a service 365 days a year are considerable.
I would rather see some of the money that is being spent on undertaking these studies used to conduct a randomised trial to determine the actual benefits and harms of routine echocardiography.
For any anaesthetic in an elderly person it is essential to maintain a stable blood pressure, and aortic stenosis is just one condition in a long list of causes for intra-operative hypotension. Concentrating our time and resources on just one cause is inappropriate and we should be looking more at ensuring patients have adequate pre-operative fluid resuscitation and the use of appropriate anaesthetic drugs and techniques.