The Management Dilemma: Concomitant Acute Hip Fracture and Severe Asymptomatic Aortic Stenosis

Abstract

Acute hip fractures (AHF) are common in elderly patients. A combination of age-related osteoporosis and increased fall risk makes this population group most susceptible to different fractures including acute fracture of the hip. AHF is a disabling condition that warrants immediate attention. It has a huge impact on the already compromised baseline functional status of elderly patients rendering them more susceptible to different morbidities and even mortality. Similarly, age-related degeneration of the aortic valve with resulting calcification also makes elderly patients prone to aortic stenosis (AS). Severe asymptomatic AS when diagnosed in these patients with AHF in the perioperative period makes the management options very challenging. Severity of AS usually translates into worse postoperative outcomes. The management rationale of concomitant presence of these two conditions is unclear. There is a lack of clear-cut recommendations and societal guidelines in such scenario.

Heyde’s Syndrome Complicating Management in a Patient With High Bleeding and Thrombotic Risks

“…Data from observational studies also show that TAVR is a reasonable alternative in a subset of patients with high surgical risk [10,11]. Our patient underwent TAVR due to high surgical risks [12]. This was coupled with plans for placement of the Watchman device due to his high bleeding risk as predicted by his high HAS-BLED score and high thrombotic risk predicted by a high CHADS2-VASc score.…”

Hip Fracture Surgery in Severe Aortic Stenosis: A Study of Factors Affecting Mortality

“…Aortic stenosis is found in no less than 5% of patients with hip fracture 1,2 and is associated with an high in-hospital and long-term mortality. [3][4][5] None of the previous investigations included only patients with severe aortic valve disease (aortic valve area <1.0 cm 2 ), [2][3][4][5]7 and therefore information on this high-risk subset of patients is limited. The National Confidential Enquiries into Perioperative Deaths (NCEPOD) recommended the use of invasive monitoring and intensive care observation after surgery for patients with aortic stenosis undergoing non-cardiac surgery, 6 particularly for procedures related to a high bleeding risk.…”