Severe Aortic Stenosis and Acute Hip Fracture: An Expedited TAVR-First Pathway

An elderly man presented with severe symptomatic aortic stenosis (AS) and an acute acetabular fracture, representing a high-risk intersection of cardiovascular and orthopedic emergencies.

What are the mechanistic and clinical links between AS and hip fracture (HFx)? How should management balance the urgency of fracture fixation with the hemodynamic instability of severe AS? What are the logistical and procedural considerations for performing transcatheter aortic valve replacement (TAVR) in this setting? What antithrombotic strategy should guide periprocedural management? Which complications can be avoided with a structured, multidisciplinary pathway?

The patient underwent expedited, minimalist transfemoral TAVR under conscious sedation on day 1, followed by HFx repair on day 2. He recovered without complications, was discharged on day 4, and remained fully independent at 1 year with stable valve function and no paravalvular leak.

In carefully selected patients with severe AS and acute HFx managed at TAVR-capable centers, a coordinated, expedited TAVR-first strategy appears feasible and may enable safe, timely orthopedic repair and recovery. Antithrombotic management must be individualized. Multidisciplinary, time-sensitive management is essential, and patient selection remains paramount.