Aim To improve quality of treatment for senile patients with pronounced aortic stenosis (AS).Material and methods Aortic valve stenosis (AS) is the most common valve pathology in cardiosurgical patients. Surgical correction of aortic valve (AV) stenosis accounts for 10 to 22 % of open-heart operations. 125 patients with pronounced AS were treated in the N. N. Burdenko Main Military Clinical Hospital between 2010 and 2017. This study was based on the implementation of new, minimally invasive methods in our clinic in 2013: balloon aortic valvuloplasty (BAVP) of the aortic valve and transcatheter aortic valve prosthesis (TCAVP).Results In the group of patients receiving the drug therapy alone, the in-hospital mortality was 2 %. At the time of maximum follow-up duration (3 years), the survival rate was 50.5 %. In the group of patients who underwent the AV replacement with extracorporeal circulation, the 3 year postoperative mortality was 16.6 %. There was no 3 year mortality in the group of patients who underwent TCAVP. The short-term beneficial effect of BAVP was confirmed.Conclusion An algorithm was developed for medical care of patients older than 75 with pronounced AS; the place of BAVP in the step-by-step management of these patients was determined. Using the developed approach in the management of these patients provided a 32 % (p<0.05) increase in the number of cases of radical surgical care.