Is preoperative balloon aortic valvuloplasty of interest for severe aortic stenosis in hip fracture surgery?. Issue 6 (June 2021)

• Record Type: Journal Article
• Authors: Ferré, Fabrice; Viarnes, Morgane; Martin, Charlotte; Bosch, Laetitia; Bouisset, Frédéric; Lhermusier, Thibault; Reina, Nicolas; Lairez, Olivier; Minville, Vincent
• Is Part Of: Injury. Volume 52:Issue 6(2021)
• Page Start: 1438
• Page End: 1444
• Publication Date: 2021-06
• Subjects: Aortic valvuloplasty -- Severe aortic stenosis -- Hip fracture; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2020.09.048
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: The incidence of degenerative aortic stenosis is frequent in people over 80 years of age. aortic stenosis is challenging in peri operative period especially after hip fracture. Preoperative balloon aortic valvuloplasty for severe aortic stenosis could reduce the mortality of hip fracture surgical patients. Abstract: Purpose: In elderly patients, the discovery and management of a severe aortic stenosis (AS) prior to emergency non-cardiac surgery is a frequent and controversial issue. The objective of this study was to evaluate preoperative balloon aortic valvuloplasty (BAV) for severe AS in hip fracture surgery. Methods: We conducted an observational, monocentric, retrospective study from 2011 to 2018. Survival (30-day, 90-day and 180-day mortality) and the occurrence of perioperative complications were analyzed and compared between control (i.e. no BAV prior to surgery) and preoperative BAV groups in patients with hip fracture surgery and a formal transthoracic echocardiographic diagnosis of severe AS (aortic valve area < 1 cm²). Patients' allocation to the intervention and control groups was after a discussion between cardiologist, anesthesiologist and the surgeon. Results: Among the 8506 patients who underwent hip fracture surgery, 29 patients in the control group and 30 patients in the BAV group were finally included. Kaplan-Meier survival analysis demonstrated a significant decrease in mortality in the BAV group (p=0.014) despite an increase in median time to operation of about 48 hours (p<0.0001). Multivariate analysis (stepwise logistic regression) showed that postoperative delirium (OR [95%CI]: 17.5 [1.8-168]; p=0.013) and postoperative acute congestive heart failure (OR [95%CI]: 59.4 [5.0-711.1]; p=0.0013) were predictive factors of 30-day mortality with an area under ROC curve of 0.90 (95%CI: 0.80-0.97; p<0.0001). Conclusions: preoperative BAV for severe AS could reduce the mortality of hip fracture patients despite an increase in time to operation . This improved survival could be linked to the decrease in cardiologic and neurologic adverse events. A larger prospective randomized study is necessary before generalizing our results.