Aortic insufficiency in elderly


 * Associate Editor-in-Chief:, Varun Kumar, M.B.B.S., Lakshmi Gopalakrishnan, M.B.B.S.

Incidence
The incidence of aortic insufficiency in the elderly is low in comparison to the incidence of aortic stenosis and mitral regurgitation. Majority of elderly patients have combined aortic stenosis and aortic insufficiency and the incidence of pure aortic insufficiency is rare.

Etiology

 * Acute aortic insufficiency in elderly is due to either aortic dissection or infective endocarditis.
 * Chronic aortic insufficiency is due to hypertension or calcific aortic stenosis or bicuspid aortic valve causing ascending aorta dilatation with resultant aortic insufficiency.

Treatment
The goal of surgery in the elderly is to improve the quality of life, hence the presence of symptoms is an important guide to determining whether or not aortic valve replacement/repair should be performed.
 * Asymptomatic chronic aortic insufficiency with evidence of marked left ventricular dilatation or left ventricular dysfunction is often recommended prophylactic ACC/AHA recommends if the risks of surgery are balanced in otherwise healthy patients against the expected improvement in long-term outcome.
 * Mild symptoms and not advanced heart failure should alert the physician to consider surgery if the regurgitation is severe.

Prognosis
Younger and middle-aged patients with aortic insufficiency have better outcomes than elderly especially in ones who are over 75years of age. Many of these patients have co-existing coronary heart diseases and develop left ventricular dysfunction and symptoms of heart failure earlier with poor postoperative survival rates.