Rotational atherectomy for calcified coronary lesions in severe aortic stenosis before transcatheter aortic valve implantation.

Objectives: Calcified coronary artery disease (CAD) is prevalent in elderly patients with degenerative severe aortic stenosis (AS). Preparation of such calcified CAD using rotational atherectomy (RA) in those patients with severe AS is controversial and may carry a high risk of complications. The authors aimed to compare in-hospital outcomes following RA in patients with severe AS before transcatheter aortic valve implantation (TAVI) vs patients without AS.

Methods: The authors retrieved data from the Prospective Segeberg TAVI Registry from January 2016 to October 2021. All AS patients who underwent RA within 6 months prior to TAVI were included for our analysis and compared with patients without AS. In-hospital MACE, defined as cardiac mortality, myocardial infarction, and target lesion revascularization was evaluated in both groups.

Results: From a total of 472 patients who underwent RA, 38 (8.1%) patients had severe AS. The group with AS was older than the group without AS (84.4 ± 6.19 vs 75.2 ± 8.31; P less than .001). About one-fourth of the RA procedures in the patients with AS were performed for aorto-ostial lesions (26.3%). Slow flow was reported in 1 (2.6%) patient in AS group, but no perforation or trapped burr was reported. In-hospital major adverse cardiovascular events (MACE) occurred in 41 (8.7%) patients and was comparable in both groups (7.9% in AS group vs 8.8% in non-AS group; P = .857). Furthermore, the presence of severe AS was not associated with occurrence of more in-hospital MACE following RA (OR 1.12: 95% CI, 0.33-3.81; P = .857). The cumulative rate of all-cause and cardiac mortality was higher in the AS group than in the non-AS group ((44.6% vs 22.2%, P = .002; 31.9% vs 17.2%, P = .017, respectively).

Conclusions: RA for preparing heavily calcified coronary lesions in patients with severe AS showed comparable in-hospital outcomes to patients without severe AS.