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. 2019 Jan 12;4(1):e000218.
doi: 10.1136/tsaco-2018-000218. eCollection 2019.

Outcome in elderly patients with aortic stenosis undergoing hip fracture surgery. Results may suggest a different postoperative strategy?

Carlo Rostagno  1   2 , Claudia Ranalli  2 , Gianluca Polidori  2 , Alessandro Cartei  2 , Alberto Boccaccini  3 , Adriano Peris  4
Affiliations

Outcome in elderly patients with aortic stenosis undergoing hip fracture surgery. Results may suggest a different postoperative strategy?

Carlo Rostagno et al. Trauma Surg Acute Care Open. .

Abstract

Background: Five to ten percent of patients with hip fracture have severe aortic valve stenosis (AS). The aim of the present investigation was to evaluate the impact of AS on early and long-term outcome after surgery for hip fracture.

Methods: 145 patients with AS and 283 consecutive patients without AS (control group) aged >70 years referred to Azienda Ospadaliera Universitaria (AOU) Careggi for hip fracture were included in the study. The endpoints were incidence of postoperative myocardial infarction, 30-day and 1-year mortality, and a composite endpoint (30-day mortality + myocardial infarction).

Results: 66 patients had mild, 47 moderate and 32 severe AS according to the European Society of Cardiology guidelines. 30-day mortality was 6.2% in AS and 3.1% in controls. Postoperative non-fatal myocardial infarction and composite endpoint were more frequent in AS than in the control group (8.3% vs 1.1%, p<0.001 and 14.5% vs 4.2%, p<0.001, respectively). The risk was significantly higher for patients with severe AS (28.1%). 1-year mortality in patients with moderate/severe AS was 46% in comparison with 16% in mild AS or in the control group (p<0.001). Coronary disease, atrial fibrillation, age, and aortic gradient were independent predictors of mortality in AS.

Discussion: AS significantly affects postoperative outcome after surgery for hip fracture. Since not infrequently AS is incidentally diagnosed during hospitalization after trauma, which should be the management in these patients after hip surgery? How many might benefit from surgical valve replacement or transcatheter aortic valve replacement? A heart team evaluation may be suggested before discharge for most of these patients.

Level of evidence: IV.

Keywords: aorta; echocardiography; elderly patients; hip fracture; outcome.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Incidence of postoperative myocardial infarction according to severity of aortic stenosis (AS) and in the control group.
Figure 2
Figure 2
Kaplan-Meier survival curves in patients with moderate-severe AS, mild AS, and the control group. AS, aortic stenosis.
See this image and copyright information in PMC

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