Aortic Stenosis Management in Patients With Acute Hip Fracture

Area of Science:

• Cardiology
• Orthopedics
• Geriatric Medicine

Background:

• Severe aortic stenosis (SAS) poses significant perioperative risks, especially for patients requiring urgent surgery.
• Hip fracture (HFx) in patients with SAS complicates management, delaying essential orthopedic treatment and recovery.
• Current strategies for managing SAS and HFx lack a clear consensus, impacting patient outcomes.

Purpose of the Study:

• To propose a management pathway for patients presenting with both severe aortic stenosis and hip fracture.
• To emphasize an early, multidisciplinary approach to optimize surgical timing and patient recovery.
• To explore the potential role of preoperative minimalist transcatheter aortic valve replacement in selected HFx-SAS patients.

Main Methods:

• Review of current literature and clinical guidelines for managing SAS and HFx.
• Development of a proposed management algorithm integrating cardiology and orthopedic care.
• Consideration of transcatheter aortic valve replacement (TAVR) as a potential preoperative strategy.

Main Results:

• Untreated SAS significantly increases perioperative risks for hip fracture surgery.
• A multidisciplinary approach can optimize the timing of orthopedic intervention.
• Preoperative minimalist TAVR may be a viable option for select patients, facilitating faster recovery.

Conclusions:

• An integrated, multidisciplinary strategy is crucial for managing patients with concurrent SAS and HFx.
• Early intervention for hip fracture is paramount to reduce morbidity and mortality.
• Preoperative TAVR should be considered for suitable patients to improve overall outcomes.