Skip to main content
SpringerLink
Log in

Clinical characteristics of elderly patients with aortic stenosis

  • Review Article
  • Published:
Journal of Echocardiography Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Chizner MA, Pearle DL, deLeon AC Jr. The natural history of aortic stenosis in adults. Am Heart J. 1980;99:419–24.

    Article  CAS  PubMed  Google Scholar 

  2. Pellikka PA, Sarano ME, Nishimura RA, et al. Outcome of 622 adults with asymptomatic, hemodynamically significant aortic stenosis during prolonged follow-up. Circulation. 2005;111:3290–5.

    Article  PubMed  Google Scholar 

  3. Kvidal P, Bergström R, Hörte LG, et al. Observed and relative survival after aortic valve replacement. J Am Coll Cardiol. 2000;35:747–56.

    Article  CAS  PubMed  Google Scholar 

  4. Bakaeen FG, Chu D, Ratcliffe M, et al. Severe aortic stenosis in a veteran population: treatment considerations and survival. Ann Thorac Surg. 2010;89:453–8.

    Article  PubMed  Google Scholar 

  5. Lung B, Cachier A, Baron G, et al. Decision-making in elderly patients with severe aortic stenosis: why are so many denied surgery? Eur Heart J. 2005;26:2714–20.

    Article  Google Scholar 

  6. Bach DS, Cimino N, Deeb GM. Unoperated patients with severe aortic stenosis. J Am Coll Cardiol. 2007;50:2018–9.

    Article  PubMed  Google Scholar 

  7. Piérard S, Seldrum S, de Meester C, et al. Incidence, determinants, and prognostic impact of operative refusal or denial in octogenarians with severe aortic stenosis. Ann Thorac Surg. 2011;91:1107–12.

    Article  PubMed  Google Scholar 

  8. Kodali SK, Williams MR, Smith CR, et al. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med. 2012;366:1686–95.

    Article  CAS  PubMed  Google Scholar 

  9. Leon MB, Smith CR, Mack M, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363:1597–607.

    Article  CAS  PubMed  Google Scholar 

  10. Makkar RR, Fontana GP, Jilaihawi H, et al. Transcatheter aortic-valve replacement for inoperable severe aortic stenosis. N Engl J Med. 2011;366:1696–704.

    Article  Google Scholar 

  11. Smith CR, Leon MB, Mack MJ, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364:2187–98.

    Article  CAS  PubMed  Google Scholar 

  12. Eltchaninoff H, Prat A, Gilard M, et al. Transcatheter aortic valve implantation: early results of the FRANCE (French Aortic National CoreValve and Edwards) registry. Eur Heart J. 2011;32:191–7.

    Article  PubMed  Google Scholar 

  13. Passik CS, Ackermann DM, Pluth JR, et al. Temporal changes in the causes of aortic stenosis: a surgical pathologic study of 646 cases. Mayo Clin Proc. 1987;62:119–23.

    Article  CAS  PubMed  Google Scholar 

  14. Bakaeen FG, Chu D, Huh J, et al. Is an age of 80 years or greater an important predictor of short-term outcomes of isolated aortic valve replacement in veterans? Ann Thorac Surg. 2010;90:769–74.

    Article  PubMed  Google Scholar 

  15. Langanay T, Flécher E, Fouquet O, et al. Aortic valve replacement in the elderly: the real life. Ann Thorac Surg. 2012;93:70–8.

    Article  PubMed  Google Scholar 

  16. Rosenhek R, Zilberszac R, Schemper M, et al. Natural history of very severe aortic stenosis. Circulation. 2010;121:151–6.

    Article  PubMed  Google Scholar 

  17. Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012): the joint task force on the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2012;33:2451–96.

    Article  PubMed  Google Scholar 

  18. Nishimura R, Otto CA, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129:e521–643.

    Article  PubMed  Google Scholar 

  19. Stortecky A, Schoenenberger AW, Moser A, et al. Evaluation of multidimensional geriatric assessment as a predictor of mortality and cardiovascular events after transcatheter aortic valve implantation. J Am Coll Cardiol Intv. 2012;5:489–96.

    Article  Google Scholar 

  20. McAlister FA, Stewart S, Ferrua S, et al. Multidisciplinary strategies for the management of heart failure patients at high risk for admission: a systematic review of randomized trials. J Am Coll Cardiol. 2004;44:810–9.

    PubMed  Google Scholar 

  21. Tsuchihashi-Makaya M, Matsuo H, Kakinoki S, et al. Home-based disease management program to improve psychological status in patients with heart failure in Japan. Circ J. 2013;77:926–33.

    Article  PubMed  Google Scholar 

  22. Kinugasa Y, Kato M, Sugihara S, et al. Multidisciplinary intensive education in the hospital improves outcomes for hospitalized heart failure patients in a Japanese rural setting. BMC Health Serv Res. 2014;14:351.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Otto CM, Lind BK, Kitzman DW, et al. Association of aortic-valve sclerosis with cardiovascular mortality and morbidity in the elderly. N Engl J Med. 1999;341:142–7.

    Article  CAS  PubMed  Google Scholar 

  24. Kume T, Kawamoto T, Okura H, et al. Rapid progression of mild to moderate aortic stenosis in patients older 80 years. J Am Soc Echocardiogr. 2007;20:1243–6.

    Article  PubMed  Google Scholar 

  25. Yamamoto K, Yamamoto H, Yoshida K, et al. Prognostic factors for progression of early- and late-stage calcific aortic valve disease in Japanese: the Japanese Aortic Stenosis Study (JASS) retrospective analysis. Hypertens Res. 2010;33:269–74.

    Article  PubMed  Google Scholar 

  26. Bahler RC, Desser DR, Finkelhor RS, et al. Factors leading to progression of valvular aortic stenosis. Am J Cardiol. 1999;84:1044–8.

    Article  CAS  PubMed  Google Scholar 

  27. Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification. Eur J Echocardiogr. 2006;7:79–108.

    Article  PubMed  Google Scholar 

  28. Maayan K, Simon B, Yan T, et al. Predictors of improvement in diastolic function after transcatheter aortic valve implantation. J Echocardiogr. 2014;12:17–23.

    Article  Google Scholar 

  29. Oshita C, Murata K, Wada Y, et al. Assessment of the aortic valve annular geometry by real-time three-dimensional transthoracic echocardiography: comparison with two-dimensional transthoracic echocardiography and multidetector computed tomography. J Echocardiogr. 2014;12:24–30.

    Article  Google Scholar 

  30. Koyama T, Okura H, Kume T, et al. Impact of energy loss index on left ventricular mass regression after aortic valve replacement. J Echocardiogr. 2014;12:51–8.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, 36-1 Nishichou, Yonago, 683-8504, Japan

    Masahiko Kato & Kazuhiro Yamamoto

Authors
  1. Masahiko Kato
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kazuhiro Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Masahiko Kato.

Ethics declarations

Conflict of interest

Masahiko Kato and Kazuhiro Yamamoto declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kato, M., Yamamoto, K. Clinical characteristics of elderly patients with aortic stenosis. J Echocardiogr 13, 134–140 (2015). https://doi.org/10.1007/s12574-015-0264-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12574-015-0264-2

Keywords

Search

Navigation