Can we perform rotational atherectomy in patients with severe aortic stenosis? Substudy from the OCEAN TAVI Registry.
OBJECTIVE
The aim of this study was to report the safety of coronary rotational atherectomy (RA) in patients with severe aortic stenosis (AS). RA in the clinical setting seems challenging because coronary slow flow leads to hemodynamic instability.


METHODS
Between October 2013 and May 2016, 1401 patients in the Optimized transCathEter vAlvular iNtervention (OCEAN) registry in Japan underwent transcatheter aortic valve implantation (TAVI). The primary study endpoint was procedural success, defined as residual stenosis <20% with final Thrombolysis in Myocardial Infarction flow 3.


RESULTS
Twenty-five patients who underwent RA for heavily calcified lesions were included in the study. Low left ventricular ejection fraction (<35%) was present in 3 (12%) patients. The left main stem was involved in 7 (28%) patients. All patients were treated under intravascular image guidance. Intra-aortic balloon pumping was used in 4 (16%) patients. Planned balloon aortic valvuloplasty (BAV) was performed during the same session in 4 (16%) patients. Transvenous catecholamine was used in 10 (40%) patients. The majority of patients underwent drug-eluting stent implantation following RA (n=23, 92%). Procedural success was achieved in all patients. Subsequent device success was achieved in 24 (96%) patients, with no 30-day mortality following TAVI.


CONCLUSIONS
RA in patients with severe AS seems extremely challenging; however, this procedure appears to be safe if mechanical and drug supports are appropriately utilized and the procedure is performed under intravascular image guidance.
New Tokyo Hospital, Matsudo, Japan. Electronic address: torunaganuma@gmail.com.
Toru
T
Naganuma
New Tokyo Hospital, Matsudo, Japan.
Hiroyoshi
H
Kawamoto
New Tokyo Hospital, Matsudo, Japan; Ogaki Municipal Hospital, Ogaki, Japan.
Kensuke
K
Takagi
New Tokyo Hospital, Matsudo, Japan.
Hiroto
H
Yabushita
New Tokyo Hospital, Matsudo, Japan.
Satoru
S
Mitomo
Teikyo University School of Medicine, Tokyo, Japan.
Yusuke
Y
Watanabe
Kokura Memorial Hospital, Kokura, Japan.
Shinichi
S
Shirai
Saiseikai Yokohama-City Eastern Hospital, Tsurumi, Japan.
Motoharu
M
Araki
Sendai Kousei Hospital, Sendai, Japan.
Norio
N
Tada
Shonan Kamakura General Hospital, Kamakura, Japan.
Futoshi
F
Yamanaka
Toyohashi Heart Center, Toyohashi, Japan.
Masanori
M
Yamamoto
New Tokyo Hospital, Matsudo, Japan.
Hirokazu
H
Onishi
New Tokyo Hospital, Matsudo, Japan.
Sunao
S
Nakamura
Kishiwada Tokushukai Hospital, Osaka, Japan.
Akihiro
A
Higashimori
Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan.
Minoru
M
Tabata
Osaka City University Graduate School of Medicine, Osaka, Japan.
Kazuki
K
Mizutani
University of Toyama, Toyama, Japan.
Hiroshi
H
Ueno
Keio University School of Medicine, Tokyo, Japan.
Kentaro
K
Hayashida
D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000503:physiopathology / Q000601:surgery*; D017225:Atherectomy, Coronary / Q000379:methods; D003331:Coronary Vessels / Q000601:surgery; D054855:Drug-Eluting Stents; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000601:surgery; D012042:Registries; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods; D016896:Treatment Outcome
Aortic stenosis; Rotational atherectomy; Transcatheter aortic valve implantation