Author + information
- Matthew Lippmanna,b,
- Jigar Patela,b,
- Jared Kvapila,b,
- Michael Pierpolinea,b,
- Peter Tadrosa,b,
- Mark Wileya,b,
- Matthew Earnesta,b,
- Ashwani Mehtaa,b,
- Eric Hockstada,b and
- Kamal Guptaa,b
Background: Percutaneous coronary intervention (PCI) followed by transcatheter valve replacement is an alternative for patients with severe aortic stenosis (SAS) and coronary artery disease (CAD). In many, the coronaries are calcific and best treated with rotational or orbital atherectomy (RA or OA) but this is not preferred in SAS patients due to safety concerns. There is paucity of data on the safety of RA/ OA in SAS patients.
Methods: This retrospective study enrolled consecutive patients with SAS who underwent elective RA or OA facilitated PCI at our center between 01/01/2011 and 12/31/2015. Medical records, procedure logs and angiograms were reviewed.
Results: Thirty patients (53.3% males, 96.7% white, mean age 79.8 + 8.6 years) were enrolled (29 RA PCI and 1 OA PCI). All PCI were completed successfully. Hypertension, hyperlipidemia, and chronic kidney disease were present in 93.3%, 60% and 53.3% respectively. Mean AV area was 0.71 + 0.18 cm2, mean AV gradient was 40.14 + 9.76 mmHg and ejection fraction was 55.5 + 13.5%. Lesion distribution was: left anterior descending (53.3%), right coronary (36.7%), circumflex (6.7%) and left main (3.3%). Mean diameter stenosis was 86.3 + 7.6%. Multi-vessel PCI was performed in 40% patients. Mean burr size was 1.5 mm (1.25 to 2 mm) and 83.3% had 4 or more burr passes. All underwent stent placement post atherectomy (mean of 1.8 stents, 12 had 2 stents and 6 had 3 stents). 93.3% received drug-eluting stents. 17 patients (56.7%) had a prophylactic pacemaker placed while 2 (6.7%) needed unplanned pacemaker during the PCI. Eight patients (26.7%) received intravenous vasopressor for transient hypotension intra-procedurally. There were no coronary perforations, 1 patient had transient no reflow and 2 (6.7%) had RA related dissections (successfully treated with stent placement). There were no procedure related stroke or death.
Conclusions: Elective RA can be performed safely in patients with severe AS and calcific CAD with low risk of complications. Transient hypotension requiring intra-procedural vasopressors appears to be more frequent than previously reported with RA in non-AS patients. More information is needed on the safety of orbital atherectomy in these patients.
Poster Contributions Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Interventional Cardiology: Structural Heart Disease
Abstract Category: 19. Interventional Cardiology: Complex Patients/Comorbidities
Presentation Number: 1241-143
- 2017 American College of Cardiology Foundation