Reducing the risk of leaflet thrombosis in transcatheter aortic valve-in-valve implantation by BASILICA: a computational simulation study

Khodaee, Farhan; Qiu, Dong; Dvir, Danny; Azadani, Ali N.

doi:10.4244/eij-d-19-00048

Cited by 11 publications

(4 citation statements)

References 4 publications

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“…We speculate that BASILICA changes blood flow patterns in the sinuses of Valsalva sequestered by the TAVR implant and in this way may reduce sinus thrombosis (27,28). It is interesting that hypo-attenuated leaflet thickening and hypoattenuation affecting motion were both observed (11% and 3%, respectively, in the first 30 days), in the prospective BASILICA trial (8) but never alongside lacerated leaflets.…”

Section: Unresolved Questions and Future Directionsmentioning

confidence: 98%

Preventing Coronary Obstruction During Transcatheter Aortic Valve Replacement

Lederman¹,

Babaliaros²,

Rogers³

et al. 2019

JACC: Cardiovascular Interventions

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124

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Coronary artery obstruction is an uncommon but devastating complication of transcatheter aortic valve replacement (TAVR). Computed tomography appears to be a sensitive but nonspecific predictor of coronary artery obstruction. Transcatheter approaches to prevent and treat coronary artery obstruction, such as “snorkel” stenting, are unsatisfactory because of serious early and late ischemic complications. Bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction during TAVR (BASILICA) is an early-stage transcatheter procedure to prevent coronary artery obstruction. It works by splitting the native or bioprosthetic leaflets so that they splay after TAVR and preserve coronary artery inflow. Because of the paucity of suitable alternatives, there is interest in the BASILICA technique despite its infancy. This tutorial review summarizes current thinking about how to predict and prevent coronary artery obstruction using BASILICA. First, the authors depict the main pathophysiological mechanisms of TAVR-associated coronary artery obstruction, along with the factors thought to contribute to coronary obstruction. Next, the authors provide a step-by-step guide to analyzing pre-procedural computed tomographic findings to assess obstruction risk and, if desirable, to plan BASILICA. Next, the authors describe the mechanisms underlying transcatheter electrosurgery. Finally, they provide step-by-step guidance on how to perform the procedure, along with a required equipment list.

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Section: Unresolved Questions and Future Directionsmentioning

confidence: 98%

Preventing Coronary Obstruction During Transcatheter Aortic Valve Replacement

Lederman¹,

Babaliaros²,

Rogers³

et al. 2019

JACC: Cardiovascular Interventions

Self Cite

124

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“…In this procedure, a guiding catheter carrying an electrified wire is directed toward aortic valve through the femoral artery and is positioned at the base of the leaflet; the electrified wire lacerates the leaflet from base to its free edge (152) and creates a split leaflet that would allow blood flow through the coronary arteries. Since the first BASILICA procedure in 2011, some clinical and computational studies have been performed to show the feasibility of BASILICA procedure and to evaluate its overall outcomes and outcomes relative to thrombosis and postoperation coronary obstruction (151)(152)(153)(154)(155)(156)(157)(158); however implications of this procedure on outcomes remain unclear (Figure 4).…”

Section: Bioprosthetic or Native Aortic Scallop Intentional Laceration Of Coronary Arterymentioning

confidence: 99%

“…Similarly, a computational study showed that the average blood residence time (BRT) on the leaflets of BASILICA computational model was about 10% less than that in the ViV computational model without leaflet laceration. It has been hypothesized that thrombus is more likely to form in regions with low flow, which can better support fibrin formation due to low advective transport (or increased BRT) (157,159,160). Therefore, the BASILICA procedure appears to reduce the risk of leaflet thrombosis in the lacerated leaflets (157).…”

Section: Bioprosthetic or Native Aortic Scallop Intentional Laceration Of Coronary Arterymentioning

confidence: 99%

“…It has been hypothesized that thrombus is more likely to form in regions with low flow, which can better support fibrin formation due to low advective transport (or increased BRT) (157,159,160). Therefore, the BASILICA procedure appears to reduce the risk of leaflet thrombosis in the lacerated leaflets (157). Additionally, a computational study showed that the hemodynamic outcome of a two-leaflet-lacerated BASILICA model is improved when compared with a one-lacerated BASILICA model and the model without laceration, but no significant difference was observed for additional leaflet laceration (three-leaflet-lacerated model) (156).…”

Section: Bioprosthetic or Native Aortic Scallop Intentional Laceration Of Coronary Arterymentioning

confidence: 99%

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Calcific Aortic Stenosis—A Review on Acquired Mechanisms of the Disease and Treatments

Zebhi

Lazkani

Bark

2021

Front. Cardiovasc. Med.

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Calcific aortic stenosis is a progressive disease that has become more prevalent in recent decades. Despite advances in research to uncover underlying biomechanisms, and development of new generations of prosthetic valves and replacement techniques, management of calcific aortic stenosis still comes with unresolved complications. In this review, we highlight underlying molecular mechanisms of acquired aortic stenosis calcification in relation to hemodynamics, complications related to the disease, diagnostic methods, and evolving treatment practices for calcific aortic stenosis.

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