Title : Resource utilization and outcomes in surgical turndown patients undergoing either orbital or rotational atherectomy
Abstract:
Patients with surgical anatomy turned down for coronary artery bypass surgery often have complex disease and high-risk features. We identified all patients who underwent either orbital (OA) or rotational atherectomy (RA) at our institution between January 2021 and December 2024, we then looked at differences between those with surgical anatomy who were turned down for surgery and those who were not evaluated for surgery.
A total of 472 patients were analyzed, the surgical turndown patients were more likely to be younger, have CKD and heart failure, with a non-significant higher rate of diabetes and prior stroke. Procedural characteristics were drastically different between the two groups with the turndown group more likely to have femoral access, a larger guide, require more stents and balloons, more likely to have large side branches with increased MCS use, fluoroscopy time and procedural time.
Despite increased MCS use and similar rates of low procedural complications, the surgical turndown group had significantly higher rates of morbidity and mortality starting at hospital discharge. Surgical turndown patients undergoing atherectomy carry especially high rates of morbidity and mortality despite increased resource utilization compared to patients undergoing atherectomy who were not evaluated for surgery.
