Lunardi Mattia, Pighi Michele, Venturi Gabriele, Del Sole Paolo Alberto, Pesarini Gabriele, Mainardi Andrea, Scarsini Roberto, Ferrero Valeria, Gottin Leonardo, Ribichini Flavio
Division of Cardiology, Department of Medicine, University of Verona, 37129 Verona, Italy.
Division of Anesthesiology, Department of Surgery, University of Verona, 37129 Verona, Italy.
J Clin Med. 2020 Dec 31;10(1):112. doi: 10.3390/jcm10010112.
Coronary artery disease (CAD) is a common finding among patients undergoing trans-catheter aortic valve implantation (TAVI), who often present severely calcified coronary lesions. Evidence is scarce about the use of rotational atherectomy (RA) in this setting, in particular regarding long-term outcome.
RA was performed on severely calcified coronary lesions concomitant with TAVI in a consecutive series of patients treated between 2010 and 2020. Immediate and long-term clinical outcomes are reported.
A concomitant CAD (coronary stenosis visually > 50%) was observed in 402/845 (47.6%) consecutive patients undergoing TAVI at the University Hospital of Verona. Angioplasty was performed in 104 patients (12.3%). Among these, 19 patients (18.3%, 20 coronary arteries), were treated with RA after TAVI: 10 after implantation of a balloon-expandable trans-catheter valve and 9 after a self-expandable valve. All procedures were successful. Hypotension occurred in 3 patients (15.8%), with rapid recovery after the procedure; CI-AKI (contrast-induced acute kidney injury) in 3 patients (15.8%), of which two recovered within discharge. At a median follow-up of 21.5 months (Q1-3: 6-36) event free survival was 83.3%. Only one patient suffered a target vessel failure >2 years after RA. Neither stroke nor peri-procedural infarctions were detected.
RA concomitant with TAVI was feasible and safe in patients treated with implantation of either self-expandable, or balloon-expandable trans-catheter aortic valves. Long-term clinical events related to the coronary procedure were extremely infrequent and the survival rate at median follow-up of 21.5 months was 83.3%.
冠状动脉疾病（CAD）在接受经导管主动脉瓣植入术（TAVI）的患者中很常见，这些患者常伴有严重钙化的冠状动脉病变。关于在这种情况下使用旋磨术（RA）的证据很少，尤其是关于长期结果。
对2010年至2020年期间连续治疗的一系列患者中，在TAVI同时对严重钙化的冠状动脉病变进行了RA。报告了即刻和长期临床结果。
在维罗纳大学医院连续接受TAVI的402/845（47.6%）例患者中观察到合并CAD（冠状动脉狭窄目测>50%）。104例患者（12.3%）进行了血管成形术。其中，19例患者（18.3%，20支冠状动脉）在TAVI后接受了RA治疗：10例在植入球囊扩张式经导管瓣膜后，9例在植入自膨胀瓣膜后。所有手术均成功。3例患者（15.8%）发生低血压，术后迅速恢复；3例患者（15.8%）发生CI-AKI（造影剂诱导的急性肾损伤），其中2例在出院前恢复。中位随访21.5个月（第一四分位数-第三四分位数：6-36）时，无事件生存率为83.3%。只有1例患者在RA后2年以上发生靶血管失败。未检测到中风或围手术期梗死。
对于接受自膨胀或球囊扩张式经导管主动脉瓣植入术治疗的患者，RA与TAVI同时进行是可行且安全的。与冠状动脉手术相关的长期临床事件极为罕见，中位随访21.5个月时的生存率为83.3%。
