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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
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Safety and Feasibility of Rotational Atherectomy in Elderly Patients With Severe Aortic Stenosis

Matthew Lippmann, Jigar Patel, Jared Kvapil

  • 1Division of Cardiovascular Diseases, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160 USA. kgupta@kumc.edu.

The Journal of Invasive Cardiology
|July 31, 2017
PubMed

Insights

Rotational atherectomy (RA)-facilitated percutaneous coronary intervention (PCI) is safe for severe aortic stenosis patients with calcified coronary arteries. Temporary hemodynamic changes occurred but without significant adverse events, demonstrating low complication risk.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • Severe aortic stenosis (AS) and coronary artery disease (CAD) often coexist.
  • Rotational atherectomy (RA) is effective for calcified coronary lesions but its safety in AS patients is debated.
  • Limited data exists on RA safety in patients with severe AS and calcific CAD.

Purpose of the Study:

  • To evaluate the safety and feasibility of RA-facilitated percutaneous coronary intervention (PCI) in patients with severe aortic stenosis and severely calcified coronary artery disease.
  • To assess procedural outcomes and complications associated with RA in this specific patient population.

Main Methods:

  • Retrospective analysis of 29 patients with severe AS undergoing RA-facilitated PCI between 2011 and 2015.
  • Data collected included patient demographics, procedural details, hemodynamic parameters, and clinical outcomes.

Main Results:

  • All 29 PCIs were technically successful in treating severe stenosis (mean 86.3%).
  • Significant but transient reductions in systolic blood pressure, diastolic blood pressure, mean arterial pressure, and heart rate were observed during RA.
  • No procedures were aborted, and there were no deaths or clinical myocardial infarctions, despite 65.5% requiring temporary pacemakers and 27.6% needing vasopressors.

Conclusions:

  • RA-facilitated PCI is a safe and feasible option for elderly patients with severe AS and severely calcified CAD.
  • Transient hemodynamic instability during RA in this cohort was not associated with adverse clinical events.
  • This approach offers a low-risk solution for managing complex coronary lesions in AS patients.
Abstract

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