Clinical characteristics of elderly patients with aortic stenosis

The number of surgical procedures performed to treat aortic stenosis (AS) has gradually been increasing with the aging of society. Advancements in technology and perioperative care have allowed surgeons to operate safely on patients regarded as high-risk, including elderly patients older than 80 years. However, approximately 30-40% of elderly patients with severe AS are reportedly still denied surgery because of high-risk factors such as old age, left ventricular dysfunction, and comorbidities. Discrepancies in therapeutic strategies might result from difficulties of risk assessment of elderly patients with AS. The current clinical guidelines recommend, in principle, aortic valve replacement (AVR) for patients with symptomatic severe AS. Among patients with asymptomatic severe AS, however, elderly patients tend not to claim any discomfort because of their reduced daily activities. Thus, some of these patients may miss good opportunities for intervention. Transcatheter aortic valve implantation, a less invasive technique than AVR, appears to be a new option for elderly patients. Physicians and cardiologists are required to make appropriate decisions regarding both patient selection and intervention timing under situations of more complex risk assessment and interventional variations. We herein outline the clinical characteristics of elderly patients with AS with consideration of the above-mentioned problems.