Objectives
We aimed to evaluate the safety and feasibility of rotational atherectomy (RA) in
patients with severe aortic stenosis (AS).
Background
Heavily calcified coronary lesions are commonly encountered in elderly patients with
severe AS who are being considered for transcatheter aortic valve implantation. The
use of RA in these patients is controversial as they may be at a higher risk of complications.
Methods
We retrospectively enrolled patients with severe AS who underwent RA across two hospitals
from March 2010 to September 2019. Patients with severe AS prior to or within 8 weeks
of RA were included.
Results
Twenty-seven (27) consecutive patients (83±5.2 yrs 63% male) with severe AS (peak
velocity 4.1±0.5 m/s, mean gradient 40.0±10.2 mmHg) were enrolled and 31 lesions were
treated with RA across 30 separate procedures. Three (3) (11.1%) patients had left
ventricular ejection fraction ≤30%. Nine (9) (30%) procedures involved percutaneous
coronary intervention of multiple arteries, with most lesions in the right coronary
artery (51.6%) and left anterior descending artery (32.3%). Three (3) (9.7%) lesions
were in the left main stem. RA-facilitated stenting was successful in all lesions.
There were no episodes of coronary perforation or slow-flow/no-reflow. There was one
episode of coronary dissection in an artery that did not undergo RA, which was successfully
treated with a drug-eluting stent. There were no deaths within 30 days and three deaths
(11.1%) within 1 year.
Conclusions
Rotational atherectomy in patients with severe AS is feasible and has a low rate of
procedural complications.
Keywords
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Article info
Publication history
Published online: March 14, 2022
Accepted:
December 5,
2021
Received in revised form:
November 20,
2021
Received:
July 6,
2021
Identification
Copyright
© 2021 Published by Elsevier B.V. on behalf of Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ).
