Case Report
Volume 8 Issue 2 - 2021
Proximal Femur Fracture in Elderly Patients with Severe Aortic Stenosis - Anaesthetic Considerations and Perioperative Care
Fábio de Souza1,2*, Márcia Karam3, Sheyla Pereira de Souza3, Osamu de Sandes Kimura4 and Kelly Biancardini Gomes Barbato1,5
1Department of Internal Medicine, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad (INTO), Rio de Janeiro, Brazil
2Cardiology Section, Universidade Federal do Estado do Rio de Janeiro, Brazil
3Department of Anesthesiology, INTO, Rio de Janeiro, Brazil
4Department of Orthopaedic Surgery, INTO, Rio de Janeiro, Brazil
5Souza Marques Medicine School, Rio de Janeiro, Brazil
*Corresponding Author: Fábio de Souza, Department of Internal Medicine, Brazilian National Institute of Traumatology and Orthopedics (INTO) and Cardiology Section, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil.
Received: November 26, 2020; Published: January 27, 2021




Abstract

Background: Severe senile aortic stenosis is associated with valve calcification and prevalence rates that increase with age. Similarly, proximal femur fracture also has a high incidence in the elderly population. Concomitance of these pathologies is a major challenge in decision making. Aortic stenosis is associated with the risk of cardiovascular events in the perioperative period, and delays in orthopaedic surgery increase morbidity and mortality.

Case Presentation: We report different perioperative and anaesthetic approaches and their respective outcomes in two cases of severe aortic stenosis in elderly patients undergoing surgical procedures for proximal femur fractures. In the first case, an 86-year-old woman initially approached with general anesthesia for hemiarthroplasty. There were many complications in the postoperative period and early hospital readmission after discharge. Eight months later the same patient suffered a periprosthetic fracture and underwent a successful surgical procedure only with peripheral block and sedation despite severe aortic stenosis and older age. In the second case, a 90-year-old woman with a proximal femur fracture was submitted to total hip arthroplasty with spinal anesthesia. Although less instability was expected, there was great difficulty in hemodynamic control in the intraoperative. The patient was observed in a longer postoperative period, being able to finally be discharged for outpatient rehabilitation.

Conclusion: Elderly patients with proximal femoral fractures and severe aortic stenosis demand an interdisciplinary medical team where cardiologists, anaesthesiologists and orthopaedists need to make decisions case-by-case. The perioperative care strategy, including anaesthetic-surgical planning, requires extensive knowledge and immense team involvement. We recommend shared decision making that presupposes the involvement of patients and their families.

Keywords: Aortic Stenosis; Proximal Femur Fracture; Perioperative Care; Anaesthesia in Orthopaedic Surgery; Case Report

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Citation: Fábio de Souza., et al. “Proximal Femur Fracture in Elderly Patients with Severe Aortic Stenosis - Anaesthetic Considerations and Perioperative Care”. EC Cardiology 8.2 (2021): 30-37.

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