Clinical experience with rotational atherectomy in patients with severe left ventricular dysfunction

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Rotational atherectomy (RA) uses a rotating diamond-crystal burr to treat complex coronary artery lesions.
• RA can generate debris, potentially causing myocardial stunning and worsening left ventricular (LV) dysfunction.
• Manufacturer guidelines advise against RA in patients with severe LV dysfunction.

Purpose of the Study:

• To assess the safety and efficacy of rotational atherectomy (RA) in patients with severe left ventricular (LV) dysfunction (LVEF < 30%).

Main Methods:

• Retrospective review of 23 patients with LVEF < 30% who underwent RA over a 4-year period.
• Analysis of patient risk factors, procedural success, and in-hospital outcomes.
• Evaluation of major adverse cardiac events at 30 days post-procedure.

Main Results:

• RA was 100% successful in lesion treatment with no in-hospital procedure-related mortality.
• Three patients experienced periprocedural myocardial infarctions; one patient died from unrelated malignancy.
• No major adverse cardiac events were observed within 30 days.

Conclusions:

• Rotational atherectomy (RA) did not adversely affect short-term outcomes in patients with severe LV dysfunction.
• RA is a safe and feasible option for selected patients with severe LV dysfunction when performed by experienced operators.