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Valvular aortic stenosis in the elderly

Wilbert S Aronow1

  • 1Cardiology Division, Department of Medicine, New York Medical College, Valhalla, New York 10595, USA. wsaronow@aol.com

Cardiology in Review
|August 19, 2007
PubMed

Insights

Elderly patients with severe aortic stenosis (AS) often have concurrent cardiovascular issues. Early aortic valve replacement (AVR) is recommended once symptoms appear to improve outcomes.

Area of Science:

  • Cardiology
  • Geriatrics

Background:

  • Elderly patients with valvular aortic stenosis (AS) frequently exhibit coronary risk factors and atherosclerotic diseases.
  • Statins show potential in mitigating AS progression.

Purpose of the Study:

  • To outline the diagnosis, management, and treatment indications for aortic stenosis in elderly patients.
  • To detail the indications for aortic valve replacement (AVR) and subsequent anticoagulation strategies.

Main Methods:

  • Physical examination findings, including prolonged duration and late peaking of aortic systolic ejection murmurs, help differentiate severe from mild AS.
  • Doppler echocardiography is the primary diagnostic tool for assessing AS prevalence and severity.

Main Results:

  • Severe AS typically manifests as angina pectoris, syncope, or congestive heart failure.
  • Aortic valve replacement (AVR) is indicated for symptomatic severe or moderate AS.

Conclusions:

  • Indefinite warfarin is recommended post-AVR for mechanical valves or bioprosthetic valves with specific risk factors (atrial fibrillation, thromboembolism, LV dysfunction, hypercoagulable condition).
  • Aspirin (75-100 mg daily) is advised for bioprosthetic valves without these risk factors.

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