Balloon Aortic Valvuloplasty as a Bridge to Urgent Hip Fracture Surgery in a Frail Elderly Patient with Severe Aortic Stenosis: A Case Report

Abstract

Severe aortic stenosis in frail older adults requiring urgent hip fracture surgery represents a major therapeutic challenge. Delaying orthopaedic repair may worsen outcomes, whereas proceeding directly to surgery in the setting of critical aortic stenosis carries substantial perioperative risk. We report the case of an 89-year-old frail woman living in a nursing home, with Alzheimer’s disease, hypertension, osteoporosis, and known severe calcific aortic stenosis, who was admitted for a left pertrochanteric hip fracture after a ground-level fall. Transthoracic echocardiography confirmed severe aortic stenosis with a peak velocity of 4.8 m/s, a mean gradient of 63 mmHg, and an indexed aortic valve area of 0.42 cm²/m², with preserved left ventricular ejection fraction. Because immediate orthopaedic surgery was considered to carry prohibitive anesthetic risk, a multidisciplinary team selected balloon aortic valvuloplasty as a bridge strategy. The procedure reduced the peak-to-peak transvalvular gradient from 75 to 20 mmHg, and post-procedural echocardiography showed a mean gradient of 26 mmHg with preserved ventricular function. Gamma nail fixation was successfully performed under general anesthesia the following day. This case highlights that balloon aortic valvuloplasty may serve as a pragmatic short-term bridge to urgent hip fracture repair in carefully selected frail patients with severe aortic stenosis who are poor candidates for immediate definitive valve intervention. Decisions should remain individualized and based on a multidisciplinary Heart Team assessment.