Key result
Single-stage CTA, PCI, and TAVR safely enables urgent hip arthroplasty in severe AS and NSTEMI.
Why the study?
Multimorbidity in geriatric patients with femoral neck fractures and concomitant severe aortic stenosis and myocardial infarction complicates perioperative management and increases mortality risk, necessitating multidisciplinary optimization strategies.
Case Report (n=1)
No
A single-stage CTA, PCI, and TAVR approach is feasible and can serve as a successful bridge to delayed orthopedic surgery in highly complex geriatric patients presenting with concurrent femoral neck fracture, severe AS, and NSTEMI.
May support single-stage cardiac optimization before urgent orthopedic surgery in select octogenarians; leaves open generalizability and outcome impact.
Geriatric femoral neck fractures are associated with high mortality. Early surgery within 48 hours improves survival, whereas delayed arthroplasty is associated with a 41% increase in mortality. Multimorbidity in this population often prolongs preoperative optimization, thereby exacerbating perioperative risk. Current evidence indicates that 5%–10% of patients with hip fractures have concomitant severe aortic stenosis (AS), which independently increases the risk of anesthesia-related complications. Perioperative acute myocardial infarction further increases mortality risk, making cardiac management a critical challenge. The advent of transcatheter aortic valve replacement (TAVR) has revolutionized care paradigms. Nonetheless, this situation requires multidisciplinary consensus on optimizing the fracture-to-surgery interval, antithrombotic bridging strategies, and concomitant coronary revascularization. Here, we present a case of single-stage aorta-coronary computed tomography angiography (CTA), percutaneous coronary intervention (PCI), and TAVR in an octogenarian with femoral neck fracture, severe AS, and non-ST-elevation myocardial infarction (NSTEMI). This pioneering case is accompanied by a systematic review of contemporary management strategies.
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Zhang et al. (2026) conducted a case report in Femoral neck fracture, NSTEMI, and severe aortic stenosis (n=1). Single-stage CTA, PCI, and TAVR was evaluated on Major adverse cardiac or orthopedic events. A single-stage CTA, TAVR, and PCI strategy successfully eliminated cardiovascular contraindications in an 84-year-old woman with NSTEMI and severe aortic stenosis, enabling successful delayed hip arthroplasty with no major adverse events at 3 months.
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