TAVR in patients with hip fracture and severe aortic stenosis: how and when?

Rostagno, Carlo; Falchetti, Giorgia; Rostagno, Andrea Carlo; Mattesini, Alessio

doi:10.1007/s11739-021-02752-6

Cited by 4 publications

(3 citation statements)

References 17 publications

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“…However, utilization of TAVI and percutaneous balloon aortic valvuloplasty (BAV) in moderate to severe AS patients during the perioperative period for time-sensitive intermediate cardiac risk surgeries, such as hip fracture, remains understudied (32). In this cohort, very few patients with hip fracture underwent TAVI in the same hospitalization.…”

Section: Discussionmentioning

confidence: 99%

Postoperative outcomes, predictors and trends of mortality and morbidity in patients undergoing hip fracture surgery with underlying aortic stenosis: A nationwide inpatient sample analysis

Hassan,

Anwar,

Mehta

et al. 2023

Preprint

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Background: Hip fractures frequently necessitate hospitalization, especially among patients aged 75 and above who might concurrently suffer from aortic stenosis (AS). This study focuses on postoperative outcomes, potential determinants of morbidity and mortality, as well as evolving trends in patients with AS undergoing surgical repair of hip fractures.Methods: A retrospective analysis of the nationwide inpatient sample from 2008 to 2019 was conducted. Hip fracture cases were identified, and a subgroup with AS was isolated using the ICD-9 and ICD-10 diagnostic codes. We compared baseline characteristics, postoperative in-hospital outcomes and trends in mortality and morbidity between patients with and without AS.Results: From the dataset, 2,834,919 patients with hip fracture were identified on weighted analysis. Of these, 94,270 (3.3%) were found to have concurrent AS. The AS cohort was characterized by higher mean age and elevated burden of cardiovascular comorbidities, such as coronary artery disease, peripheral vascular disease, pulmonary hypertension, congestive heart failure and cardiac arrhythmias. Postoperative mortality following hip fracture surgery was greater in the AS groups compared to non-AS group (3.3% vs 1.57%, p < 0.001). Risk factors such as congestive heart failure (OR, 2.3[CI, 2.1–2.6]), age above 85 years (OR, 3.2[CI, 2.2–4.7]), cardiac arrhythmias (OR, 2.4[CI, 2.2–2.6]), end-stage renal disease (OR, 3.4[CI, 2.7–4.1]), malnutrition (OR, 2.3[CI, 2.1–2.7]) and AS (OR, 1.2[CI, 1.08–1.5] were associated with increased adjusted odds of postoperative mortality. AS was linked to higher adjusted odds of postoperative mortality (OR, 1.2 [CI, 1.1–1.5]) and complications such as acute myocardial infarction (OR, 1.2 [CI, 1.01–1.4]), cardiogenic shock (OR, 2.0[CI, 1.4–2.9]) and acute renal failure (OR, 1.1[CI, 1.02–1.2]). While hospital stay duration was comparable in both groups (average 5 days), the AS group incurred higher costs (mean $50,673 vs $44,607). The presence of acute heart failure in patients with AS and hip fracture significantly increased mortality, hospital stay, and cost. A notable decline in postoperative in-hospital mortality was observed in both groups from 2008–2019 though the rate of major in-hospital complications rose.Conclusion: AS significantly influences postoperative in-hospital mortality and complication rates in hip fracture patients. While a reduction in postoperative mortality was observed in both AS and non-AS cohorts, the incidence of major in-hospital complications increased across both groups.

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Section: Discussionmentioning

confidence: 99%

Postoperative outcomes, predictors and trends of mortality and morbidity in patients undergoing hip fracture surgery with underlying aortic stenosis: A nationwide inpatient sample analysis

Hassan,

Anwar,

Mehta

et al. 2023

Preprint

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“…Previous clinical studies [11,12] have shown that patients with severe limb trauma are often hypercoagulable due to abnormal changes in the coagulation system. Both intrinsic coagulation factors and extrinsic coagulation pathways are considered to play a role in this phenomenon, with the latter being a key contributing factor.…”

Section: Discussionmentioning

confidence: 99%

Effect of hemocoagulase on the coagulation parameters, blood transfusion volume and bleeding volume of patients with severe traumatic fractures

2023

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To investigate the effect of hemocoagulase on coagulation parameters, blood transfusion volume and bleeding volume in patients with severe traumatic fractures. A total of 116 patients with severe traumatic fractures admitted to our hospital. These patients were randomly divided into the study group (hemocoagulase injection) and control group (normal saline injection), with 58 patients in each group. The bleeding time, coagulation time, perioperative bleeding volume, blood transfusion volume, hematology and coagulation parameters of the two groups were observed and compared. At 24 h post-surgery, the bleeding time and coagulation time were significantly shorter in the study group than in the control group (p < 0.05). The intraoperative bleeding volume, 24 h postoperative drainage volume, and blood transfusion volume were significantly lower in the study group than in the control group (p < 0.05). In addition, the 24 h postoperative levels of hematology parameters were significantly higher in the study group than in the control group (p < 0.05). However, coagulation parameters were similar in both groups before and at 24 h after surgery. Hemocoagulase has a better hemostatic effect and can effectively reduce perioperative bleeding without affecting the coagulation functions of patients with severe traumatic fractures. Therefore, hemocoagulase is a reliable treatment regimen in clinical practice.

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“… 35 , 36 , 37 , 38 , 39 On the other hand, only small registries have analyzed the role of introducing TAVR in the setting of NCS. 23 , 40 , 41 , 42 , 43 However, after introducing TAVR in the therapeutic toolbox, more geriatric and high-risk patients became candidates for 2-staged operations, where HOS became the most common NCS. 42 …”

Section: Management Of Severe Aortic Stenosis In Patients With Acute ...mentioning

confidence: 99%

Aortic Stenosis Management in Patients With Acute Hip Fracture

Terré,

Torrado,

George

et al. 2024

JACC: Advances

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TAVR in patients with hip fracture and severe aortic stenosis: how and when?

Cited by 4 publications

References 17 publications

Postoperative outcomes, predictors and trends of mortality and morbidity in patients undergoing hip fracture surgery with underlying aortic stenosis: A nationwide inpatient sample analysis

Postoperative outcomes, predictors and trends of mortality and morbidity in patients undergoing hip fracture surgery with underlying aortic stenosis: A nationwide inpatient sample analysis

Effect of hemocoagulase on the coagulation parameters, blood transfusion volume and bleeding volume of patients with severe traumatic fractures

Aortic Stenosis Management in Patients With Acute Hip Fracture

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