Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Aug 7;14(15):5560.
doi: 10.3390/jcm14155560.

Calcific Aortic Valve Stenosis: A Focal Disease in Older and Complex Patients-What Could Be the Best Time for an Appropriate Interventional Treatment?

Annamaria Mazzone  1 , Augusto Esposito  1 , Ilenia Foffa  1   2 , Sergio Berti  1   2
Affiliations
Review

Calcific Aortic Valve Stenosis: A Focal Disease in Older and Complex Patients-What Could Be the Best Time for an Appropriate Interventional Treatment?

Annamaria Mazzone et al. J Clin Med. .

Abstract

Calcific aortic stenosis (CAS) is a newly emerging pandemic in elderly individuals due to the aging of the population in the world. Surgical Aortic Valve Replacement (SAVR) and Transcatheter Aortic Valve Replacement (TAVR) are the cornerstone of the management of severe aortic stenosis accompanied by one or more symptoms. Moreover, an appropriate interventional treatment of CAS, in elderly patients, is a very complex decision for heart teams, to avoid bad outcomes such as operative mortality, cardiovascular and all-cause death, hospitalization for heart failure, worsening of quality of life. In fact, CAS in the elderly is not only a focal valve disease, but a very complex clinical picture with different risk factors and etiologies, differing underlying pathophysiology, large phenotypic heterogeneity in a context of subjective biological, phenotypic and functional aging until frailty and disability. In this review, we analyzed separately and in a more integrated manner, the natural and prognostic histories of the progression of aortic stenosis, the phenotypes of myocardial damage and heart failure, within the metrics and aging trajectory. The aim is to suggest, during the clinical timing of valve disease, the best interval time for an appropriate and effective interventional treatment in each older patient, beyond subjective symptoms by integration of clinical, geriatric, chemical, and advanced imaging biomarkers.

Keywords: appropriate interventional treatment; biomarkers; management of severe aortic stenosis; older patient.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Trajectories of the natural histories of aortic stenosis, heart failure and frailty, within the aging process in older patient candidates for interventional treatment of CAS with heart failure and a preserved ejection fraction (HFpEF). The two vertical dotted lines identify an ideal time for an appropriate interventional treatment in older patients.
Figure 2
Figure 2
A strategy of multidimensional evaluation during clinical surveillance in elderly patients with calcific aortic stenosis to identify the appropriate time for interventional treatment.
See this image and copyright information in PMC

References

    1. Nkomo V.T., Gardin J.M., Skelton T.N., Gottdiener J.S., Scott C.G., Enriquez-Sarano M. Burden of valvular heart diseases: A population-based study. Lancet. 2006;368:1005–1011. doi: 10.1016/S0140-6736(06)69208-8. - DOI - PubMed
    1. Ross J., Jr., Braunwald E. Aortic stenosis. Circulation. 1968;38((Suppl. 1S5)):61–67. doi: 10.1161/01.CIR.38.1S5.V-61. - DOI - PubMed
    1. Otto C.M., Newby D.E., Hillis G.S. Calcific Aortic Stenosis: A Review. JAMA. 2024;332:2014–2026. doi: 10.1001/jama.2024.16477. - DOI - PubMed
    1. Damluji A.A., Bernacki G., Afilalo J., Lyubarova R., Orkaby A.R., Kwak M.J., Hummel S., Kirkpatrick J.N., Maurer M.S., Wenger N., et al. TAVR in Older Adults: Mowing Towards a Comprehensive Geriatric Assessment and Away from Chronological Age: JACC Family Series. JACC Adv. 2024;3:100877. doi: 10.1016/j.jacadv.2024.100877. - DOI - PMC - PubMed
    1. Mazzone A., Del Turco S., Trianni G., Quadrelli P., Marotta M., Bastiani L., Gasbarri T., D’Agostino A., Mariani M., Basta G., et al. The Positive Impact of Early Frailty Levels on Mortality in Elderly Patients with Severe Aortic Stenosis Undergoing Transcatheter/Surgical Aortic Valve Replacement. J. Cardiovasc. Dev. Dis. 2023;10:212. doi: 10.3390/jcdd10050212. - DOI - PMC - PubMed

LinkOut - more resources