Elderly patients complicated with underlying diseases are very common, and it is daunting to clinical work due to all kinds of complex cases. The patient was 90 years old, and complicated cardiopulmonary disease eventually led to heart failure, requiring cystolithotomy cystolithectomy. Adequate preoperative evaluation, multi‑disciplinary cooperation to realize organ function optimization and change of surgical methods were carried out, reasonable intraoperative anesthesia plan, the use of advanced monitoring methods to pay close attention to the patient's vital signs, optimized fluid management to minimize the perioperative risk of the patient safely, and finally cured and discharged without severe complications.