Aortic valve disease in older persons

The prevalence of aortic stenosis (AS) and aortic regurgitation (AR) increases with age. The evaluation and management of an older patient with aortic valve disease includes a full assessment of other medical comorbidities and functional frailty, as these variables affect the treatment outcomes. AS and chronic AR are well tolerated for many years; however, the prognosis becomes very poor once the symptoms appear. Several characteristic findings on physical exam can help in the initial diagnosis of aortic valve disease and provide an idea of its severity. Echocardiography is the primary imaging tool to diagnose and assess the severity of aortic valve diseases. Surgical aortic valve replacement (AVR) has been the treatment of choice in patients requiring invasive treatment for aortic valve diseases. However, a significant proportion of older patients were either not referred, were inoperable, or were at high risk for surgical AVR due to their comorbidities. Advancements in minimally invasive surgical and transcatheter aortic valve replacement (TAVR) treatment options have provided an alternative for older patients who are otherwise inoperable or high-risk candidates for AVR. In this chapter we discuss the etiology, prevalence, diagnosis, and treatment options for AS and AR in older patients.