Can we perform rotational atherectomy in patients with severe aortic stenosis? Substudy from the OCEAN TAVI Registry

Toru Naganuma, Hiroyoshi Kawamoto, Kensuke Takagi, Hiroto Yabushita, Satoru Mitomo, Yusuke Watanabe, Shinichi Shirai, Motoharu Araki, Norio Tada, Futoshi Yamanaka, Masanori Yamamoto, Hirokazu Onishi, Sunao Nakamura, Akihiro Higashimori, Minoru Tabata, Kazuki Mizutani, Hiroshi Ueno, Kentaro Hayashida

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Purpose: 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.

Original languageEnglish
JournalCardiovascular Revascularization Medicine
DOIs
Publication statusAccepted/In press - 2016 Nov 29

Fingerprint

Coronary Atherectomy
Aortic Valve Stenosis
Registries
Transcatheter Aortic Valve Replacement
Intra-Aortic Balloon Pumping
Balloon Valvuloplasty
Drug-Eluting Stents
Stroke Volume

Keywords

  • Aortic stenosis
  • Rotational atherectomy
  • Transcatheter aortic valve implantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Can we perform rotational atherectomy in patients with severe aortic stenosis? Substudy from the OCEAN TAVI Registry. / Naganuma, Toru; Kawamoto, Hiroyoshi; Takagi, Kensuke; Yabushita, Hiroto; Mitomo, Satoru; Watanabe, Yusuke; Shirai, Shinichi; Araki, Motoharu; Tada, Norio; Yamanaka, Futoshi; Yamamoto, Masanori; Onishi, Hirokazu; Nakamura, Sunao; Higashimori, Akihiro; Tabata, Minoru; Mizutani, Kazuki; Ueno, Hiroshi; Hayashida, Kentaro.

In: Cardiovascular Revascularization Medicine, 29.11.2016.

Research output: Contribution to journalArticle

Naganuma, T, Kawamoto, H, Takagi, K, Yabushita, H, Mitomo, S, Watanabe, Y, Shirai, S, Araki, M, Tada, N, Yamanaka, F, Yamamoto, M, Onishi, H, Nakamura, S, Higashimori, A, Tabata, M, Mizutani, K, Ueno, H & Hayashida, K 2016, 'Can we perform rotational atherectomy in patients with severe aortic stenosis? Substudy from the OCEAN TAVI Registry', Cardiovascular Revascularization Medicine. https://doi.org/10.1016/j.carrev.2017.02.018
Naganuma, Toru ; Kawamoto, Hiroyoshi ; Takagi, Kensuke ; Yabushita, Hiroto ; Mitomo, Satoru ; Watanabe, Yusuke ; Shirai, Shinichi ; Araki, Motoharu ; Tada, Norio ; Yamanaka, Futoshi ; Yamamoto, Masanori ; Onishi, Hirokazu ; Nakamura, Sunao ; Higashimori, Akihiro ; Tabata, Minoru ; Mizutani, Kazuki ; Ueno, Hiroshi ; Hayashida, Kentaro. / Can we perform rotational atherectomy in patients with severe aortic stenosis? Substudy from the OCEAN TAVI Registry. In: Cardiovascular Revascularization Medicine. 2016.
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title = "Can we perform rotational atherectomy in patients with severe aortic stenosis? Substudy from the OCEAN TAVI Registry",
abstract = "Purpose: 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.",
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T1 - Can we perform rotational atherectomy in patients with severe aortic stenosis? Substudy from the OCEAN TAVI Registry

AU - Naganuma, Toru

AU - Kawamoto, Hiroyoshi

AU - Takagi, Kensuke

AU - Yabushita, Hiroto

AU - Mitomo, Satoru

AU - Watanabe, Yusuke

AU - Shirai, Shinichi

AU - Araki, Motoharu

AU - Tada, Norio

AU - Yamanaka, Futoshi

AU - Yamamoto, Masanori

AU - Onishi, Hirokazu

AU - Nakamura, Sunao

AU - Higashimori, Akihiro

AU - Tabata, Minoru

AU - Mizutani, Kazuki

AU - Ueno, Hiroshi

AU - Hayashida, Kentaro

PY - 2016/11/29

Y1 - 2016/11/29

N2 - Purpose: 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.

AB - Purpose: 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.

KW - Aortic stenosis

KW - Rotational atherectomy

KW - Transcatheter aortic valve implantation

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U2 - 10.1016/j.carrev.2017.02.018

DO - 10.1016/j.carrev.2017.02.018

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JF - Cardiovascular Revascularization Medicine

SN - 1553-8389

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