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Int J Angiol 2022; 31(04): 232-243
DOI: 10.1055/s-0042-1759527
DOI: 10.1055/s-0042-1759527
Invited Article
Diagnosis and Management of Aortic Valvular Disease in the Elderly
Abstract
Aortic valvular disease, including aortic stenosis and aortic regurgitation, is increasingly common with age. Due to the aging population, more elderly patients are presenting with aortic valve pathology and expectations for prompt diagnosis and efficacious treatment. The current paradigm for aortic valve disease is based on surgical or interventional therapy. In this review, we discuss the approach to diagnosing aortic valvular disease and the different options for treatment based on the most recent evidence.
Keywords
aortic valve disease - aortic dilation - cardiac biomarkers - cardiac surgery - cardiovascular surgical disease - diagnostic procedure - valvuloplastyPublikationsverlauf
Artikel online veröffentlicht:
29. November 2022
© 2022. International College of Angiology. This article is published by Thieme.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
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References
- 1 “elderly, adj.”. OED Online. June 2022. Oxford University Press, Accessed on June 30, 2022 at: https://www.oed.com/
- 2 Schettler G. Prävention der Herz- und Gefässkrankheiten. Lebensversicher Med 1984; 36 (08) 170-173
- 3 Vespa J, Medina L, Armstrong D. Demographic Turning Points for the United States: Population Projections for 2020 to 2060 Current Population Reports, P25–1144. Washington, DC: US Census Bureau; . US Census Bur; Published online 2018: 1-13
- 4 Fruitman DS, MacDougall CE, Ross DB. Cardiac surgery in octogenarians: can elderly patients benefit? Quality of life after cardiac surgery. Ann Thorac Surg 1999; 68 (06) 2129-2135
- 5 Zingone B, Gatti G, Rauber E. et al. Early and late outcomes of cardiac surgery in octogenarians. Ann Thorac Surg 2009; 87 (01) 71-78
- 6 Hoogendijk EO, Afilalo J, Ensrud KE, Kowal P, Onder G, Fried LP. Frailty: implications for clinical practice and public health. Lancet 2019; 394 (10206): 1365-1375
- 7 Sepehri A, Beggs T, Hassan A. et al. The impact of frailty on outcomes after cardiac surgery: a systematic review. J Thorac Cardiovasc Surg 2014; 148 (06) 3110-3117
- 8 Skaar E, Eide LSP, Norekvål TM. et al. A novel geriatric assessment frailty score predicts 2-year mortality after transcatheter aortic valve implantation. Eur Heart J Qual Care Clin Outcomes 2019; 5 (02) 153-160
- 9 Rockwood K, Song X, MacKnight C. et al. A global clinical measure of fitness and frailty in elderly people. CMAJ 2005; 173 (05) 489-495
- 10 Lee JA, Yanagawa B, An KR, Arora RC, Verma S, Friedrich JO. Canadian Cardiovascular Surgery Meta-Analysis Working Group. Frailty and pre-frailty in cardiac surgery: a systematic review and meta-analysis of 66,448 patients. J Cardiothorac Surg 2021; 16 (01) 184
- 11 Yanagawa B, Graham MM, Afilalo J, Hassan A, Arora RC. Frailty as a risk predictor in cardiac surgery: Beyond the eyeball test. J Thorac Cardiovasc Surg 2019; 157 (05) 1905-1909
- 12 Tseng EE, Wisneski AD. Pathophysiology of the aortic valve. In: Baumgartner WA, Jacobs JP, Darling GE. eds. Adult and Pediatric Cardiac Surgery. STS Cardiothoracic Surgery E-Book. Chicago: Society of Thoracic Surgeons. 2020. ebook.sts.org . Accessed June 30, 2022
- 13 Misfeld M, Sievers HH. Heart valve macro- and microstructure. Philos Trans R Soc Lond B Biol Sci 2007; 362 (1484): 1421-1436
- 14 Lindman BR, Bonow RO, Otto CM. Current management of calcific aortic stenosis. Circ Res 2013; 113 (02) 223-237
- 15 Owens DS, Katz R, Takasu J, Kronmal R, Budoff MJ, O'Brien KD. Incidence and progression of aortic valve calcium in the Multi-ethnic Study of Atherosclerosis (MESA). Am J Cardiol 2010; 105 (05) 701-708
- 16 Novaro GM, Katz R, Aviles RJ. et al. Clinical factors, but not C-reactive protein, predict progression of calcific aortic-valve disease: the Cardiovascular Health Study. J Am Coll Cardiol 2007; 50 (20) 1992-1998
- 17 Rosenhek R, Klaar U, Schemper M. et al. Mild and moderate aortic stenosis. Natural history and risk stratification by echocardiography. Eur Heart J 2004; 25 (03) 199-205
- 18 Otto CM, Burwash IG, Legget ME. et al. Prospective study of asymptomatic valvular aortic stenosis. Clinical, echocardiographic, and exercise predictors of outcome. Circulation 1997; 95 (09) 2262-2270
- 19 Miura S, Arita T, Kumamaru H. et al. Causes of death and mortality and evaluation of prognostic factors in patients with severe aortic stenosis in an aging society. J Cardiol 2015; 65 (05) 353-359
- 20 Essop MR, Nkomo VT. Rheumatic and nonrheumatic valvular heart disease: epidemiology, management, and prevention in Africa. Circulation 2005; 112 (23) 3584-3591
- 21 Sievers HH, Schmidtke C. A classification system for the bicuspid aortic valve from 304 surgical specimens. J Thorac Cardiovasc Surg 2007; 133 (05) 1226-1233
- 22 Mathieu P, Bossé Y, Huggins GS. et al. The pathology and pathobiology of bicuspid aortic valve: State of the art and novel research perspectives. J Pathol Clin Res 2015; 1 (04) 195-206
- 23 Jermihov PN, Jia L, Sacks MS, Gorman RC, Gorman III JH, Chandran KB. Effect of geometry on the leaflet stresses in simulated models of congenital bicuspid aortic valves. Cardiovasc Eng Technol 2011; 2 (01) 48-56
- 24 Tibazarwa KB, Volmink JA, Mayosi BM. Incidence of acute rheumatic fever in the world: a systematic review of population-based studies. Heart 2008; 94 (12) 1534-1540
- 25 Zühlke L, Engel ME, Lemmer CE. et al. The natural history of latent rheumatic heart disease in a 5 year follow-up study: a prospective observational study. BMC Cardiovasc Disord 2016; 16 (01) 46
- 26 Eveborn GW, Schirmer H, Heggelund G, Lunde P, Rasmussen K. The evolving epidemiology of valvular aortic stenosis. the Tromsø study. Heart 2013; 99 (06) 396-400
- 27 Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. Lancet 2006; 368 (9540): 1005-1011
- 28 Singh JP, Evans JC, Levy D. et al. Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study). Am J Cardiol 1999; 83 (06) 897-902
- 29 Ross Jr J, Braunwald E. Aortic stenosis. Circulation 1968; 38 (suppl 1): 61-67
- 30 Braunwald E. Aortic stenosis: then and now. Circulation 2018; 137 (20) 2099-2100
- 31 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 (24) 3290-3295
- 32 Rahko PS. Doppler and echocardiographic characteristics of patients having an Austin Flint murmur. Circulation 1991; 83 (06) 1940-1950
- 33 Chin CWL, Messika-Zeitoun D, Shah ASV. et al. A clinical risk score of myocardial fibrosis predicts adverse outcomes in aortic stenosis. Eur Heart J 2016; 37 (08) 713-723
- 34 Torres-Ramalho P, Araújo JP, Bettencourt P, Moura LM. Natriuretic peptides in aortic stenosis. Rev Port Cardiol 2012; 31 (10) 655-660
- 35 Chin CWL, Djohan AH, Lang CC. The role of cardiac biochemical markers in aortic stenosis. Biomarkers 2016; 21 (04) 316-327
- 36 Saeed S, Wasim D, Mohamed Ali A, Bleie Ø, Chambers JB. The electrocardiogram: Still a useful marker for LV fibrosis in aortic stenosis. J Electrocardiol 2021; 65 (65) 82-87
- 37 Maganti K, Rigolin VH, Sarano ME, Bonow RO. Valvular heart disease: diagnosis and management. Mayo Clin Proc 2010; 85 (05) 483-500
- 38 Clavel MA, Pibarot P, Messika-Zeitoun D. et al. Impact of aortic valve calcification, as measured by MDCT, on survival in patients with aortic stenosis: results of an international registry study. J Am Coll Cardiol 2014; 64 (12) 1202-1213
- 39 Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte Jr M, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 1990; 15 (04) 827-832
- 40 Francone M, Budde RPJ, Bremerich J. et al. Correction to: CT and MR imaging prior to transcatheter aortic valve implantation: standardisation of scanning protocols, measurements and reporting-a consensus document by the European Society of Cardiovascular Radiology (ESCR). Eur Radiol 2020; 30 (07) 4143-4144
- 41 Jassal DS, Shapiro MD, Neilan TG. et al. 64-slice multidetector computed tomography (MDCT) for detection of aortic regurgitation and quantification of severity. Invest Radiol 2007; 42 (07) 507-512
- 42 Baumgartner H, Hung J, Bermejo J. et al. Recommendations on the echocardiographic assessment of aortic valve stenosis: a focused update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging 2017; 18 (03) 254-275
- 43 Otto CM, Nishimura RA, Bonow RO. et al. 2020 ACC/AHA Guideline for the Management of Patients with Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Vol 143. 2021.
- 44 Clavel MA, Magne J, Pibarot P. Low-gradient aortic stenosis. Eur Heart J 2016; 37 (34) 2645-2657
- 45 Faber M, Sonne C, Rosner S. et al. Predicting the need of aortic valve surgery in patients with chronic aortic regurgitation: a comparison between cardiovascular magnetic resonance imaging and transthoracic echocardiography. Int J Cardiovasc Imaging 2021; 37 (10) 2993-3001
- 46 Woldendorp K, Bannon PG, Grieve SM. Evaluation of aortic stenosis using cardiovascular magnetic resonance: a systematic review & meta-analysis. J Cardiovasc Magn Reson 2020; 22 (01) 45
- 47 Bekeredjian R, Grayburn PA. Valvular heart disease: aortic regurgitation. Circulation 2005; 112 (01) 125-134
- 48 Farmer JA. Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis (the SEAS trial). Curr Atheroscler Rep 2009; 11 (02) 82-83
- 49 Cowell SJ, Newby DE, Prescott RJ. et al; Scottish Aortic Stenosis and Lipid Lowering Trial, Impact on Regression (SALTIRE) Investigators. A randomized trial of intensive lipid-lowering therapy in calcific aortic stenosis. N Engl J Med 2005; 352 (23) 2389-2397
- 50 Helske S, Otto CM. Lipid lowering in aortic stenosis: still some light at the end of the tunnel?. Circulation 2009; 119 (20) 2653-2655
- 51 Moura LM, Ramos SF, Zamorano JL. et al. Rosuvastatin affecting aortic valve endothelium to slow the progression of aortic stenosis. J Am Coll Cardiol 2007; 49 (05) 554-561
- 52 Hachicha Z, Dumesnil JG, Pibarot P. Usefulness of the valvuloarterial impedance to predict adverse outcome in asymptomatic aortic stenosis. J Am Coll Cardiol 2009; 54 (11) 1003-1011
- 53 Briand M, Dumesnil JG, Kadem L. et al. Reduced systemic arterial compliance impacts significantly on left ventricular afterload and function in aortic stenosis: implications for diagnosis and treatment. J Am Coll Cardiol 2005; 46 (02) 291-298
- 54 O'Brien KD, Probstfield JL, Caulfield MT. et al. Angiotensin-converting enzyme inhibitors and change in aortic valve calcium. Arch Intern Med 2005; 165 (08) 858-862
- 55 Alsidawi S, Couto M, López-Candales A. Acquired Von Willebrand syndrome in aortic stenosis: case report and review. Bol Asoc Med P R 2015; 107 (02) 86-88
- 56 King RM, Pluth JR, Giuliani ER. The association of unexplained gastrointestinal bleeding with calcific aortic stenosis. Ann Thorac Surg 1987; 44 (05) 514-516
- 57 Ishii K, Hirota Y, Suwa M, Kita Y, Onaka H, Kawamura K. Natural history and left ventricular response in chronic aortic regurgitation. Am J Cardiol 1996; 78 (03) 357-361
- 58 Lin M, Chiang HT, Lin SL. et al. Vasodilator therapy in chronic asymptomatic aortic regurgitation: enalapril versus hydralazine therapy. J Am Coll Cardiol 1994; 24 (04) 1046-1053
- 59 Shah RM, Singh M, Bhuriya R, Molnar J, Arora RR, Khosla S. Favorable effects of vasodilators on left ventricular remodeling in asymptomatic patients with chronic moderate-severe aortic regurgitation and normal ejection fraction: a meta-analysis of clinical trials. Clin Cardiol 2012; 35 (10) 619-62
- 60 Thourani VH, Myung R, Kilgo P. et al. Long-term outcomes after isolated aortic valve replacement in octogenarians: a modern perspective. Ann Thorac Surg 2008; 86 (05) 1458-1464 , discussion 1464–1465
- 61 Mølstad P, Veel T, Rynning S. Long-term survival after aortic valve replacement in octogenarians and high-risk subgroups. Eur J Cardiothorac Surg 2012; 42 (06) 934-940
- 62 Bacchetta MD, Ko W, Girardi LN. et al. Outcomes of cardiac surgery in nonagenarians: a 10-year experience. Ann Thorac Surg 2003; 75 (04) 1215-1220
- 63 Elsisy MF, Schaff HV, Crestanello JA, Alkhouli MA, Stulak JM, Stephens EH. Outcomes of cardiac surgery in nonagenarians. J Card Surg 2022; 37 (06) 1664-1670
- 64 Kvidal P, Bergström R, Hörte LG, Ståhle E. Observed and relative survival after aortic valve replacement. J Am Coll Cardiol 2000; 35 (03) 747-756
- 65 Stewart BF, Siscovick D, Lind BK. et al. Clinical factors associated with calcific aortic valve disease. Cardiovascular Health Study. J Am Coll Cardiol 1997; 29 (03) 630-634
- 66 Pibarot P, Dumesnil JG. Improving assessment of aortic stenosis. J Am Coll Cardiol 2012; 60 (03) 169-180
- 67 Paradis JM, Fried J, Nazif T. et al. Aortic stenosis and coronary artery disease: what do we know? What don't we know? A comprehensive review of the literature with proposed treatment algorithms. Eur Heart J 2014; 35 (31) 2069-2082
- 68 Hannan EL, Wu C, Bennett EV. et al. Risk index for predicting in-hospital mortality for cardiac valve surgery. Ann Thorac Surg 2007; 83 (03) 921-929
- 69 Cappabianca G, Ferrarese S, Musazzi A. et al. Predictive factors of long-term survival in the octogenarian undergoing surgical aortic valve replacement: 12-year single-centre follow-up. Heart Vessels 2016; 31 (11) 1798-1805
- 70 Kuo K, Shah P, Hiebert B. et al. Predictors of survival, functional survival, and hospital readmission in octogenarians after surgical aortic valve replacement. J Thorac Cardiovasc Surg 2017; 154 (05) 1544-1553.e1
- 71 ElBardissi AW, Shekar P, Couper GS, Cohn LH. Minimally invasive aortic valve replacement in octogenarian, high-risk, transcatheter aortic valve implantation candidates. J Thorac Cardiovasc Surg 2011; 141 (02) 328-335
- 72 Chiariello GA, Bruno P, Villa E. et al. Aortic valve replacement in elderly patients with small aortic annulus: results with three different bioprostheses. Innovations (Phila) 2019; 14 (01) 27-36
- 73 Wong CHM, Chan JSK, Sanli D, Rahimli R, Harky A. Aortic valve repair or replacement in patients with aortic regurgitation: a systematic review and meta-analysis. J Card Surg 2019; 34 (06) 377-384
- 74 Zeeshan A, Idrees JJ, Johnston DR. et al. Durability of aortic valve cusp repair with and without annular support. Ann Thorac Surg 2018; 105 (03) 739-748
- 75 Urbanski PP, Jankulovski A, Doldurov K. et al. Reconstructive aortic valve surgery in the elderly: techniques and outcomes. J Thorac Cardiovasc Surg 2018; 155 (04) 1414-1420
- 76 Carroll JD, Mack MJ, Vemulapalli S. et al. STS-ACC TVT registry of transcatheter aortic valve replacement. Ann Thorac Surg 2021; 111 (02) 701-722
- 77 Leon MB, Smith CR, Mack M. et al; PARTNER Trial Investigators. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 2010; 363 (17) 1597-1607
- 78 Smith CR, Leon MB, Mack MJ. et al; PARTNER Trial Investigators. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 2011; 364 (23) 2187-2198
- 79 Leon MB, Smith CR, Mack MJ. et al; PARTNER 2 Investigators. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med 2016; 374 (17) 1609-1620
- 80 Mack MJ, Leon MB, Thourani VH. et al; PARTNER 3 Investigators. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med 2019; 380 (18) 1695-1705
- 81 Gleason TG, Reardon MJ, Popma JJ. et al; CoreValve U.S. Pivotal High Risk Trial Clinical Investigators. 5-year outcomes of self-expanding transcatheter versus surgical aortic valve replacement in high-risk patients. J Am Coll Cardiol 2018; 72 (22) 2687-2696
- 82 Reardon MJ, Van Mieghem NM, Popma JJ. et al; SURTAVI Investigators. Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N Engl J Med 2017; 376 (14) 1321-1331
- 83 Svensson LG, Adams DH, Bonow RO. et al. Aortic valve and ascending aorta guidelines for management and quality measures. Ann Thorac Surg 2013; 95 (suppl 6): S1-S66
- 84 Tarus A, Tinica G, Bacusca A, Artene B, Popa IV, Burlacu A. Coronary revascularization during treatment of severe aortic stenosis: a meta-analysis of the complete percutaneous approach (PCI plus TAVR) versus the complete surgical approach (CABG plus SAVR). J Card Surg 2020; 35 (08) 2009-2016