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Degenerative aortic stenosis. One effect of the graying of America
J H O'Keefe1, C J Lavie, R A Nishimura
1Cardiovascular Consultants, Mid America Heart Institute, Kansas City, Missouri.
Insights
Degenerative calcific aortic stenosis is a serious geriatric issue. While aortic valve replacement is preferred for symptomatic severe aortic stenosis, medical management and Doppler echocardiography monitoring are suitable for asymptomatic patients with normal heart function.
Area of Science:
- Cardiology
- Geriatric Medicine
- Valvular Heart Disease
Background:
- Degenerative calcific aortic stenosis is an increasing concern in the elderly population.
- Symptomatic severe aortic stenosis is a lethal condition with limited medical treatment options.
- Existing interventions like aortic balloon valvuloplasty offer palliation but do not change the disease's prognosis.
Purpose of the Study:
- To review the management strategies for degenerative calcific aortic stenosis.
- To highlight the challenges and considerations in treating elderly patients with severe aortic stenosis.
- To outline the role of medical therapy and monitoring in asymptomatic cases.
Main Methods:
- Review of current medical literature and clinical guidelines.
- Analysis of treatment outcomes for aortic stenosis in geriatric populations.
- Discussion of diagnostic tools such as Doppler echocardiography.
Main Results:
- Aortic valve replacement is the definitive treatment for symptomatic severe aortic stenosis.
- Elderly patients undergoing aortic valve replacement face significant perioperative risks.
- Comorbid cardiac conditions can increase the likelihood of postoperative complications.
- Asymptomatic severe aortic stenosis with preserved left ventricular function warrants medical management and serial monitoring.
Conclusions:
- Management of severe aortic stenosis requires careful consideration of patient age, symptoms, and comorbidities.
- For asymptomatic severe aortic stenosis, non-invasive monitoring with Doppler echocardiography is appropriate.
- Aortic valve replacement remains the gold standard for symptomatic severe aortic stenosis, despite risks in the elderly.
Abstract:
Degenerative calcific aortic stenosis is evolving as a common geriatric problem. Once symptoms develop, it is a highly lethal disease that does not respond well to medical therapy. Aortic balloon valvuloplasty may offer palliation but is unlikely to alter the overall course of the disease. Aortic valve replacement is the therapy of choice, but high perioperative morbidity and mortality rates can be expected in the very elderly. The presence of other appreciable cardiac disorders may contribute to the occurrence of postoperative complications. Patients with asymptomatic aortic stenosis and normal left ventricular function can be treated medically and followed with serial aortic valve area determinations using Doppler echocardiography.