The Use of BASILICA Technique to Prevent Coronary Obstruction in a TAVI-TAVI Procedure

Abstract

Transcatheter aortic valve implantation (TAVI) to manage structural bioprosthetic valve deterioration has been successful in mitigating the risk of a redo cardiac surgery. However, TAVI-in-TAVI is a complex intervention, potentially associated with feared complications such as coronary artery obstruction. Coronary obstruction risk is especially high when the previously implanted prosthesis had supra-annular leaflets and/or the distance between the prosthesis and the coronary ostia is short. The BASILICA technique (bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction) was developed to prevent coronary obstruction during native or valve-in-valve interventions but has now also been considered for TAVI-in-TAVI interventions. Despite its utility, the technique requires a not so widely available toolbox. Herein, we discuss the TAVI-in-TAVI BASILICA technique and how to perform it using more widely available tools, which could spread its use.

Aktuelle Weiterentwicklungen und Fortschritte in der Herzchirurgie

“…Das BASILICA-Verfahren (Bioprosthetic or native Aortic Scallop Intentional Laceration to prevent Iatrogenic Coronary Artery obstruction) hat in solchen komplexen anatomischen Situationen neue Therapieoptionen ermöglicht [11]. Dabei wird mittels Elektrodraht eine V-förmige Lazeration in der degenerierten Prothese gesetzt, womit eine verbesserte Koronarperfusion des anulusnahen Koronargefäßes nach Re-Klappenersatz ermöglicht werden kann.…”

Transcatether Aortic Valve Implantation to Treat Degenerated Surgical Bioprosthesis: Focus on the Specific Procedural Challenges

“…An emergent preventive measure of coronary occlusion is the bioprosthetic or native aortic scallop intentional (BASILICA) ( 38 ). A prospective multicenter study enrolled 30 patients have demonstrated that BASILICA was feasible in native and bioprosthetic valves ( 39 ) and nowdays this technique is also proposed to prevent coronary obstruction in TAVI in TAVI procedure ( 40 ). However it cannot be ignored that this technique requires a learning curve and is associated with a not negligible stroke rates even in experienced centers ( 39 ).…”

The Heart in the Transcatheter Intervention Era: Where Are We?

“…This Special Issue of the Journal of Clinical Medicine (JCM) entitled “Transcatheter Structural Heart Disease Interventions: Clinical Update” offers eight original articles and four review articles. Ten articles focus on the transcatheter aortic valve approach, discussing all the relevant issues related to this technique, such as balloon aortic valvoplasty [ 15 ]; TAVI indications and patient selection [ 16 ]; pre-procedural planning [ 17 ]; access routes (open or percutaneous vascular access) [ 18 ]; potential access-related complications [ 19 ]; TAVI outcomes compared with surgery [ 20 ]; challenges of surgery after TAVI failure [ 21 ]; post-TAVI prognostic factors [ 22 ]; potential benefits of cerebral embolic protection devices [ 23 ]; and the BASILICA technique to prevent coronary obstruction [ 24 ]. Three additional articles discuss the state of the art in transcatheter mitral valve replacement images [ 25 ]; atrial functional tricuspid regurgitation [ 26 ]; and the use of different diagnostic catheters for transradial coronary angiography [ 27 ].…”