Valvular Heart Disease in the Elderly

Abstract

Clinicians are increasingly caring for elderly patients with valvular heart disease due in part to an aging population and
a decline in rheumatic heart disease. Aortic stenosis (AS) and mitral regurgitation (MR) are the most common valve lesions
encountered. Calcific AS represents a disease spectrum from aortic sclerosis to severe, symptomatic AS; the latter of which
has a significantly limited prognosis. Surgical aortic valve replacement is the recommended therapy and can improve life expectancy.
Although increased age is associated with a slight increase in surgical risk, co-morbidities are primarily associated with
increased surgical risk. If approved, transcatheter aortic valve implantation may be an option in some patient subsets pending
the results of multi-center randomized controlled trials. MR in the elderly population may be associated with primary left
ventricular dysfunction (functional MR) or primary MR (leaflet disease). Both are associated with heart failure and can result
in increased morbidity. Therapy for functional MR is aimed at the medical treatment for heart failure. Therapy for primary
MR is aimed at surgery if accepted indications exist.

KeywordsAortic stenosis–Mitral regurgitation–Valve disease–Valvular heart disease–Elderly