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Valvular heart disease in elderly adults

INTRODUCTION

The diagnosis and management of valvular heart disease in elderly adults has been affected by the dramatic increase in life expectancy that began in the last half of the 20th century. In the United States, for example, the number of persons aged 80 years or older is expected to increase from 6.9 million in 1990 to approximately 25 million by the year 2050 [1]. As a result, degenerative valve disease is likely to become an increasing problem. Furthermore, the prevalence of valvular disease is increasing with age, with more than one in eight people age 75 and older having moderate or severe valve disease [2].

Fortunately, there have been major advances in cardiac surgery, which affect the consideration of surgical treatment in elderly patients who in the past may not have been surgical candidates. Among patients who survive the surgery and perioperative period, the level of function and quality of life and, in some studies, survival are the same as in a general population of age-matched subjects [3-5]. As a result, the classic view that surgery should be considered only for elderly patients in excellent general condition is being challenged as higher success rates are obtained in patients with comorbidities that are not serious or, if uncontrolled, not overwhelming [6]. Additionally, development of percutaneous valvular interventions will further increase therapeutic choices for elderly adults. Indeed, the success of transcatheter aortic valve replacement (TAVR) has spurred active development efforts for mitral and tricuspid valve disease [7,8]. (See "Transcatheter aortic valve replacement".)

Studies have used various age criteria to identify elderly adults. Although there are no comprehensive population-based data regarding the prevalence of valvular heart disease, several studies have provided important information about the prevalence of significant valvular heart disease, stratified by age (table 1). Aortic stenosis, organic and ischemic (functional) mitral regurgitation, and tricuspid regurgitation are the most common valvular disorders in elderly adults.

AORTIC STENOSIS

Calcific or degenerative aortic valve disease is considered the most common valvular lesion encountered among elderly patients [9-11]. In the Helsinki Aging Study, 501 randomly selected men and women aged 75 to 86 underwent imaging and Doppler echocardiography [10,11]. The prevalence of at least moderate aortic stenosis, defined as an aortic valve area (AVA) ≤1.2 cm2 and velocity ratio ≤0.35, was 5 percent; the prevalence of critical aortic stenosis (AVA ≤0.8 cm2, and velocity ratio ≤0.25) increased with age from 1 to 2 percent in persons 75 to 76 years of age up to almost 6 percent in those 86 years of age [11]. Moderate or severe aortic stenosis was more frequent in women (8.8 versus 3.6 percent in men) [10]. (See "Aortic valve area in aortic stenosis".)

Similar prevalences have been reported from referral centers and nursing home populations, with an even higher prevalence in those over 90 years of age [12,13].

                         

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Literature review current through: Nov 2014. | This topic last updated: Oct 28, 2013.
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