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Simultaneous transcatheter aortic valve implantation and femoral osteosynthesis: a case report
Yuki Mitsuta1, Yukiko Okamura2, Yosuke Miyamoto2
1Department of Anesthesiology, Japanese Red Cross Kumamoto Hospital, 2-1-1, Nagamine-Minami, Higashi-Ku, Kumamoto, 861-8520, Japan. yuu0042001@yahoo.co.jp.
Insights
Simultaneous transcatheter aortic valve implantation (TAVI) and femoral osteosynthesis were successfully performed in a 90-year-old patient. Meticulous preparation ensured a favorable outcome for this complex combined procedure.
Area of Science:
- Cardiology
- Orthopedic Surgery
- Geriatric Medicine
Background:
- Simultaneous cardiac and non-cardiac surgeries offer patient benefits but are infrequently reported.
- Elderly patients with multiple comorbidities present unique challenges for combined procedures.
Purpose of the Study:
- To describe the feasibility and successful outcome of simultaneous transcatheter aortic valve implantation (TAVI) and femoral osteosynthesis.
- To highlight the importance of meticulous planning and perioperative management in complex combined surgeries.
Main Methods:
- A 90-year-old female with severe aortic stenosis and femoral trochanteric fracture underwent same-day TAVI and femoral osteosynthesis under general anesthesia.
- Preoperative simulation, careful anesthetic management, and intraoperative monitoring, including temporary pacing for bradycardia, were employed.
- Transfemoral TAVI was followed by femoral osteosynthesis, with successful extubation and recovery.
Main Results:
- The combined procedure was completed without significant intraoperative complications.
- The patient experienced no noticeable postoperative complications and achieved successful rehabilitation.
- This case demonstrates the successful application of a multidisciplinary approach in high-risk elderly patients.
Conclusions:
- Simultaneous TAVI and femoral osteosynthesis can be safely performed with careful planning and execution.
- Meticulous perioperative management is crucial for favorable outcomes in elderly patients undergoing combined cardiac and orthopedic procedures.
- This approach offers a viable option for patients requiring simultaneous treatment for severe aortic stenosis and hip fracture.
Background:
Simultaneous cardiac and non-cardiac surgeries can be beneficial for patients, but there are still few reports on this approach.
Case Presentation:
A 90-year-old woman was diagnosed with a femoral trochanteric fracture and severe aortic stenosis. A heart team conference decided to perform transcatheter aortic valve implantation (TAVI) and femoral osteosynthesis under general anesthesia on the same day. A preoperative simulation was conducted to review the surgical procedure and confirm the arrangement of the operating table and instruments. Preoperative management was carried out with attention to the risk of myocardial ischemia caused by bleeding or pain from the fracture. Transfemoral TAVI was completed without trouble, and after the patient was moved to the traction table, osteosynthesis was started. Back-up pacing with a temporary pacemaker was activated for atrioventricular block and bradycardia. After completing the surgery, the patient recovered from anesthesia, and extubation was performed after confirming the absence of paralysis. The patient had no noticeable postoperative complications and successfully underwent rehabilitation.
Conclusions:
Through meticulous preparation and perioperative management, we were able to perform TAVI and femoral osteosynthesis simultaneously, achieving a favorable outcome.
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