Coronary Rotational Atherectomy in Patients Treated with Transcatheter Aortic Valve Implantation

ABSTRACT

Background: To report about the feasibility and safety of myocardial revascularization, using rotational atherectomy (RA) in patients treated with transcatheter aortic valve implantation (TAVI). Coronary artery disease (CAD) in the elderly with calcific aortic valve stenosis (AVS) is frequent and often presents severely calcified coronary lesions. However, no information is available regarding the use of RA, and whether it should be performed before, during or after the valve implantation.

Methods: RA was performed on severely calcified coronary lesions after TAVI in a consecutive series of patients treated between 2010 and 2018. Immediate and long-term clinical outcomes were monitored prospectively.

Results: A concomitant CAD (coronary stenosis visually > 50%) was observed in 237/535 patients (44%). Mean Logistic EuroSCORE of these patients was 23.6 ± 18.7%. Angioplasty was performed in 90 patients (17%) and 16 (18%) were treated with RA in 17 coronary arteries after TAVI, 9 after implantation of a balloon-expandable transcatheter valve, and 7 after a self-expandable valve. All procedures were successful and had no immediate complications. Non-significant troponin rise occurred in all cases and two patients needed transient dialysis. At a median follow-up of 24.2 months (range 3–47 months) all patients except two were alive and improved their renal function compared to baseline. One death was for cardiac reasons. One patient had a recurrence of angina due to an occlusive intra-stent restenosis.

Conclusions: RA after TAVI is feasible and safe in patients treated with implantation of either self- or balloon-expandable transcatheter aortic valves.

KEYWORDS:

• High-risk aortic valve stenosis
• transcatheter aortic valve implantation
• catheter-based coronary interventions
• rotational atherectomy
• percutaneous coronary interventions

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All authors meet the authorship criteria according to the latest guidelines of the International Committee of Medical Journal Editors, and they are in agreement with the manuscript.

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Authors have not received any funding related to this article.