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Aortic stenosis: current treatment options for a common condition in old age

Published online by Cambridge University Press:  27 March 2012

D Tiwari ,
J Radvan  and
SC Allen
D Tiwari
Affiliation:
The Royal Bournemouth Hospital, Bournemouth University, Poole, UK
J Radvan
Affiliation:
The Royal Bournemouth Hospital, Bournemouth University, Poole, UK
SC Allen*
Affiliation:
Centre for Postgraduate Medical Research and Education, Bournemouth University, Poole, UK
*
Address for correspondence: Professor S.C. Allen, Postpoint A10, The Royal Bournemouth Hospital, Castle Lane East, Bournemouth BH7 7DW, UK. Email: Stephen.allen@rbch.nhs.uk
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Summary

Degenerative-calcific aortic stenosis is mainly a disease of old age. Patients with mild to moderate stenosis without symptoms and those with aortic valve sclerosis do not require mechanical intervention. There is no firm evidence that the rate of progression can be modified by medical therapies, though statins might have some effect. Patients who develop severe stenosis with symptoms have a very poor prognosis if managed medically. Surgical aortic valve replacement greatly improves symptoms and mortality rates and remains the treatment of choice for those fit for major surgery, even above the age of 80 years. For those not suitable for surgery, or who are unwilling to have an operation, outcomes can be significantly improved by trans-catheter aortic valve replacement, which has become an important option for frail elderly patients. Balloon aortic valvuloplasty improves symptoms and short-term survival, but has a less clear impact on mortality beyond 1 year. It is useful as a palliative treatment and as a bridging procedure for patients who are not ready for valve replacement. There is less agreement on the best approach to patients with asymptomatic severe aortic stenosis. Trials indicate that early valve replacement results in outcomes that are comparable to those seen in symptomatic patients, though guidelines advocate delaying surgery until symptoms occur or left ventricular function begins to decline rapidly. All elderly patients with severe aortic stenosis should be considered for a mechanical intervention unless there is a properly considered reason for not doing so, or they are not willing to receive such treatment.

Keywords

aortic stenosisaortic valve replacementelderlyold age
Type
Clinical geriatrics
Information
Reviews in Clinical Gerontology , Volume 22 , Issue 3 , August 2012 , pp. 195 - 203
Copyright
Copyright © Cambridge University Press 2012

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