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Peer-reviewedCC BY 4.0Journal of Clinical Medicine

Preoperative Ballon Aortic Valvuloplasty vs. Conservative Management in Patients Undergoing Hip Fracture Surgery with Underlying Severe Aortic Stenosis

  • Antonio De Vita1,2
  • Marcello Covino1,3
  • Francesco Mollo1
  • Matteo Vumbaca1
  • Chiara Napolitano1
  • Saverio Tremamunno1,2
  • Nello Cambise2
  • Rosaria Natali2
  • Marco Rossi4
  • Tiziana Bove4
  • Raffaele Vitiello5
  • Giulio Maccauro5
4 more authors
  • Francesco Franceschi1,3
  • Carlo Trani1,2
  • Francesco Burzotta1,2
  • Gaetano Antonio Lanza1,2
5 affiliations
  1. 1Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome Campus, 00168 Rome, Italy
  2. 2Department of Cardiovascular Sciences, Fondazione Policlinico Universitario a. Gemelli IRCCS, 00168 Rome, Italy
  3. 3Department of Emergency Medicine, Fondazione Policlinico Universitario a. Gemelli IRCCS, 00168 Rome, Italy
  4. 4Department of Emergency, Anesthesiologic and Reanimation Sciences, Fondazione Policlinico Universitario a. Gemelli IRCCS, 00168 Rome, Italy
  5. 5Department of Ageing, Neurosciences, Head-Neck and Orthopedics Sciences, Fondazione Policlinico Universitario a. Gemelli IRCCS, 00168 Rome, Italy
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Abstract

Background: Old adults with hip fracture (HFx) and concomitant severe aortic stenosis (AS) represent a high-risk population in whom urgent orthopedic repair is usually required, while definitive valve replacement is rarely feasible preoperatively. The clinical benefit of balloon aortic valvuloplasty (BAV) as a bridging strategy remains uncertain. Methods: In this observational study, we included patients admitted to our Emergency Department for HFx who had concomitant severe AS. Management of severe AS consisted of either conservative therapy or preoperative BAV. The early clinical endpoints included 30-day mortality, time to surgery, length of intensive care unit and hospital stay and need for mechanical ventilation. The late clinical endpoint was 180-day all-cause mortality. Results: Among 3958 patients admitted for HFx fracture, 46 (1.2%) were found to have severe AS and fulfilled the inclusion criteria. Of these, 12 patients (26.1%) underwent preoperative BAV and 34 (73.9%) received conservative management. Thirty-day mortality was 8.3% in the BAV group and 23.5% in the conservative group (HR 0.32; 95%CI 0.04–2.60; p = 0.29). Time to surgery was longer in the BAV group (p < 0.001) with concomitantly longer hospital (p = 0.001) and ICU (p = 0.041) stays. Preoperative BAV was independently associated with lower 180-day mortality (HR 0.13; 95%CI 0.03–0.63; p = 0.011). Conclusions: In patients with severe AS undergoing urgent HFx repair, preoperative BAV was associated with reduced 180-day mortality, suggesting a potential long-term prognostic benefit, which warrants confirmation in larger prospective studies. However, it was not associated with significantly better 30-day survival and was accompanied by surgical delay and greater healthcare resource utilization.

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Cite

BibTeXRIS
BibTeX
@article{vita2026preoperative,
  title = {{Preoperative Ballon Aortic Valvuloplasty vs. Conservative Management in Patients Undergoing Hip Fracture Surgery with Underlying Severe Aortic Stenosis}},
  author = {Antonio De Vita and Marcello Covino and Francesco Mollo and Matteo Vumbaca and Chiara Napolitano and Saverio Tremamunno and Nello Cambise and Rosaria Natali and Marco Rossi and Tiziana Bove and Raffaele Vitiello and Giulio Maccauro and Francesco Franceschi and Carlo Trani and Francesco Burzotta and Gaetano Antonio Lanza},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = oct,
  doi = {10.3390/jcm15208160},
  url = {https://www.mdpi.com/2077-0383/15/20/8160},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Preoperative Ballon Aortic Valvuloplasty vs. Conservative Management in Patients Undergoing Hip Fracture Surgery with Underlying Severe Aortic Stenosis
AU  - Antonio De Vita
AU  - Marcello Covino
AU  - Francesco Mollo
AU  - Matteo Vumbaca
AU  - Chiara Napolitano
AU  - Saverio Tremamunno
AU  - Nello Cambise
AU  - Rosaria Natali
AU  - Marco Rossi
AU  - Tiziana Bove
AU  - Raffaele Vitiello
AU  - Giulio Maccauro
AU  - Francesco Franceschi
AU  - Carlo Trani
AU  - Francesco Burzotta
AU  - Gaetano Antonio Lanza
PY  - 2026
DA  - 2026/10/01
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15208160
UR  - https://www.mdpi.com/2077-0383/15/20/8160
AB  - Background: Old adults with hip fracture (HFx) and concomitant severe aortic stenosis (AS) represent a high-risk population in whom urgent orthopedic repair is usually required, while definitive valve replacement is rarely feasible preoperatively. The clinical benefit of balloon aortic valvuloplasty (BAV) as a bridging strategy remains uncertain. Methods: In this observational study, we included patients admitted to our Emergency Department for HFx who had concomitant severe AS. Management of severe AS consisted of either conservative therapy or preoperative BAV. The early clinical endpoints included 30-day mortality, time to surgery, length of intensive care unit and hospital stay and need for mechanical ventilation. The late clinical endpoint was 180-day all-cause mortality. Results: Among 3958 patients admitted for HFx fracture, 46 (1.2%) were found to have severe AS and fulfilled the inclusion criteria. Of these, 12 patients (26.1%) underwent preoperative BAV and 34 (73.9%) received conservative management. Thirty-day mortality was 8.3% in the BAV group and 23.5% in the conservative group (HR 0.32; 95%CI 0.04–2.60; p = 0.29). Time to surgery was longer in the BAV group (p < 0.001) with concomitantly longer hospital (p = 0.001) and ICU (p = 0.041) stays. Preoperative BAV was independently associated with lower 180-day mortality (HR 0.13; 95%CI 0.03–0.63; p = 0.011). Conclusions: In patients with severe AS undergoing urgent HFx repair, preoperative BAV was associated with reduced 180-day mortality, suggesting a potential long-term prognostic benefit, which warrants confirmation in larger prospective studies. However, it was not associated with significantly better 30-day survival and was accompanied by surgical delay and greater healthcare resource utilization.
SN  - 2077-0383
ER  -