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

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.