Author + information
- Received December 31, 2018
- Revision received April 8, 2019
- Accepted April 11, 2019
- Published online July 1, 2019.
- Robert J. Lederman, MDa,∗ (, )
- Vasilis C. Babaliaros, MDb,
- Toby Rogers, PhD, BM, BCha,c,
- Jaffar M. Khan, BM, BCha,
- Norihiko Kamioka, MDb,
- Danny Dvir, MDd and
- Adam B. Greenbaum, MDb
- aCardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MarylandCardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
- bEmory University, Atlanta, GeorgiabEmory University, Atlanta, Georgia
- cMedstar Washington Hospital Center, Washington, District of ColumbiaMedstar Washington Hospital Center, Washington, District of Columbia
- dDivision of Cardiology, University of Washington, Seattle, WashingtonDivision of Cardiology, University of Washington, Seattle, Washington
- ↵∗Address for correspondence:
Dr. Robert J. Lederman, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room 2c713, MSC 1538, Bethesda, Maryland 20892-1538.
• CT is sensitive but nonspecific to identify risk for TAVR-induced coronary obstruction.
• BASILICA may prevent coronary obstruction in cases of native and valve-in-valve TAVR.
• BASILICA is applicable to sinus sequestration and deficient-sinus mechanisms.
• BASILICA is complex with available equipment, but dedicated equipment may simplify it.
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.
- cardiac computed tomography
- coronary artery obstruction
- transcatheter aortic valve replacement
- transcatheter electrosurgery
- virtual valve
- virtual valve-to-coronary distance
This work was supported by grant Z01-HL006040 from the National Heart, Lung, and Blood Institute Division of Intramural Research (to Dr. Lederman). Drs. Lederman, Rogers, and Khan are co-inventors on patents assigned to the National Institutes of Health for purpose-built devices intended to lacerate valve leaflets. Dr. Rogers is a proctor for Edwards Lifesciences and Medtronic. Dr. Greenbaum is a proctor for Edwards Lifesciences, Medtronic, and Abbott Vascular; holds equity in Transmural Systems; and receives research support to his employer from Edwards Lifesciences, Abbott Vascular, Medtronic, and Boston Scientific. Dr. Babaliaros is a consultant for Edwards Lifesciences and Abbott Vascular; and receives research support to his employer from Edwards Lifesciences, Abbott Vascular, Medtronic, and Boston Scientific. Dr. Dvir is a consultant for Edwards Lifesciences, Medtronic, and Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 31, 2018.
- Revision received April 8, 2019.
- Accepted April 11, 2019.
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