Aortic Stenosis Management in Patients With Acute Hip Fracture

Juan A. Terré, Juan Torrado, Isaac George, Rafael Harari, Pedro R. Cox-Alomar, Pedro A. Villablanca, Robert T. Faillace, Juan F. Granada, George Dangas, Mario J. Garcia, Azeem Latib, José Wiley

Research output: Contribution to journalReview articlepeer-review

Abstract

The treatment of severe aortic stenosis (SAS) has evolved rapidly with the advent of minimally invasive structural heart interventions. Transcatheter aortic valve replacement has allowed patients to undergo definitive SAS treatment achieving faster recovery rates compared to valve surgery. Not infrequently, patients are admitted/diagnosed with SAS after a fall associated with a hip fracture (HFx). While urgent orthopedic surgery is key to reduce disability and mortality, untreated SAS increases the perioperative risk and precludes physical recovery. There is no consensus on what the best strategy is either hip correction under hemodynamic monitoring followed by valve replacement or preoperative balloon aortic valvuloplasty to allow HFx surgery followed by valve replacement. However, preoperative minimalist transcatheter aortic valve replacement may represent an attractive strategy for selected patients. We provide a management pathway that emphasizes an early multidisciplinary approach to optimize time for hip surgery to improve orthopedic and cardiovascular outcomes in patients presenting with HFx-SAS.

Original languageEnglish
Article number100912
JournalJACC: Advances
Volume3
Issue number5
DOIs
StatePublished - May 2024

Keywords

  • HOS
  • SAVR
  • TAVR
  • aortic stenosis
  • balloon aortic valvuloplasty
  • hip fracture
  • hip fracture surgery
  • management
  • minimalist transcatheter aortic valve replacement
  • non cardiac surgery
  • protocol
  • transcatheter aortic valve replacement
  • treatment algorithm

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