* My O-360 spends nearly all of its life at 75% power. It's made it to TBO several times. 2000 hours at an average speed of 120 miles per hour is the equivalent of 240,000 miles
* All reciprocating engines are "ancient designs." There's no difference in car, boat, airplane or stationary engines in this regard. They all have crankshafts running in plain bearings with reciprocating pistons and a valve train. There's no fundamental difference between a car engine and an aircraft engine in terms of design
That said, there's a ton of technology in an aircraft engine. There's a forged crankshaft that was cast in a vacuum. You don't see that in automotive applications. There are sodium-filled exhaust valves. Again, you don't see that technology in an automotive application. There are fuel injection systems, dual sets of spark plugs, crankshaft vibration (Sarazin/Chilton) dampers. Won't find those on an automotive crankshaft
And, by virtue of being high-displacement, low-RPM engines they are remarkably fuel efficient -- especially when compared to automotive engines. The direct drive versions have no losses associated with reduction gearing, like in an auto engine. The lower swept area per HP output means less loss to friction, etc.