Published online Feb 26, 2019. doi: 10.4330/wjc.v11.i2.71
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
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.
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.