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World J Cardiol. Feb 26, 2019; 11(2): 71-83
Published online Feb 26, 2019. doi: 10.4330/wjc.v11.i2.71
Heart valve disease in elderly
Carlo Rostagno
Carlo Rostagno, Department of Internal Medicine, University of Florence, Florence 50134, Italy
Author contributions: Rostagno C solely contributed to this paper.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Carlo Rostagno, MD, PhD, Associate Professor, Department of Internal Medicine, University of Florence, Viale Morgagni 85, Firenze 50134, Italy. carlo.rostagno@unifi.it
Telephone: +39-55-7948063 Fax: +39-55-7947587
Received: December 18, 2018
Peer-review started: December 20, 2018
First decision: December 30, 2018
Revised: January 13, 2019
Accepted: January 26, 2019
Article in press: January 26, 2019
Published online: February 26, 2019
Processing time: 69 Days and 8.2 Hours
Abstract

The incidence of heart valve disease increases significantly with age. Degenerative abnormalities associated with severe aortic stenosis and mitral and tricuspid regurgitation are found in not less than 10% of the population aged ≥ 75 years. Surgical treatment has been considered for years to be the treatment of choice. However, it was not uncommonly associated with high perioperative morbidity and mortality due to frequent comorbidities and overall frailty conditions of these patients. Conventional risk scores such as Society of Thoracic Surgeons and European System for Cardiac Operative Risk Evaluation may underestimate the risk of surgery in elderly patients, leading to inappropriate surgical indication. On the other hand, at least 30% of patients with severe conditions are left untreated due to prohibitive surgical risk. Interventional procedures, which are in continuous development, may be actually considered for high risk patients and, as recent results suggest, also for intermediate risk patients.

Keywords: Valve diseases; Elderly; Surgery; Interventional cardiology

Core tip: Severe heart valve diseases are not uncommon in the elderly and often treatment may be challenging due to high risks related both to relevant comorbidities and the frailty condition of elderly patients. Although surgery is still the first choice for most conditions, interventional strategies are emerging as a valid alternative both in high and intermediate risk patients. Careful evaluation is needed for each individual patient in order to establish a more appropriate strategy considering that the impact on the quality of life may be more relevant in this population than the effects on survival, which is already limited by decreased life expectancy related to ageing.