INDICATIONS FOR SURGICAL TREATMENT OF AORTIC STENOSIS IN ELDERLY PEOPLE

Abstract

Introduction: Aortic stenosis is the most prevalent valvular disease in the elderly, with an estimated incidence of 3-5% in the population over 75 years of age, associated with high morbidity and mortality when left untreated. In its severe form, the disease significantly reduces life expectancy, especially when accompanied by symptoms such as dyspnea, syncope or angina, a scenario in which the average survival is less than two years. Surgical treatment, traditionally based on prosthetic valve replacement (SAVR), remains the gold standard, even in octogenarian patients, with positive short- and long-term results. Indications for intervention include not only the presence of symptoms, but also echocardiographic and hemodynamic criteria, such as left ventricular ejection fraction (LVEF) <50%, aortic velocity >5 m/s, severe pulmonary hypertension or rapid progression of valvular calcification. Multidisciplinary assessment, including risk scales such as EuroSCORE II and STS, is crucial to define the ideal approach, especially in frail elderly individuals or those with complex comorbidities. Objective: This systematic review aimed to analyze recent scientific evidence on indications for surgical treatment of aortic stenosis in elderly individuals, focusing on clinical criteria, complementary exams, and patient selection strategies. Methodology: The methodology followed the PRISMA checklist, using the PubMed, Scielo, and Web of Science databases, with descriptors in Portuguese and English: "aortic stenosis," "elderly," "surgical treatment," "heart valve prostheses," and "life expectancy." Articles published in the last 10 years, observational studies, and clinical trials that addressed intervention criteria in patients over 65 years of age were included. Narrative reviews, case reports, and studies focusing exclusively on percutaneous techniques (TAVI) without comparison with conventional surgery were excluded. Results: The reviewed studies highlighted that the presence of symptoms, reduced LVEF and hemodynamic severity (aortic velocity >5 m/s) are primary indications for surgery. Asymptomatic patients were considered candidates in cases of ventricular dysfunction, abnormal response to stress testing or progressive valve calcification. Assessment of surgical risk using predictive scales and frailty analysis were decisive in the choice between SAVR and TAVI. Postoperative complications, such as bleeding and infection, were more frequent in the elderly, but five-year survival reached 70-80% in specialized centers. Conclusion: Surgical intervention for severe aortic stenosis in the elderly is feasible and beneficial when based on rigorous clinical criteria and complementary exams. Individualized selection, considering surgical risk, comorbidities and life expectancy, is essential to optimize outcomes. Although SAVR remains the gold standard, TAVI emerges as a valid alternative for high-risk patients, reinforcing the importance of the integrated role of the Heart Team in therapeutic decision-making