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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
Summary
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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:

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  • 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.