Prevention of coronary obstruction in patients at risk undergoing transcatheter aortic valve implantation: the Hamburg BASILICA experience

• Published in: Clinical research in cardiology Vol. 110; no. 12; pp. 1900 - 1911
• Main Authors: Westermann, Dirk, Ludwig, Sebastian, Kalbacher, Daniel, Spink, Clemens, Linder, Matthias, Bhadra, Oliver D., Nikorowitsch, Julius, Waldschmidt, Lara, Demal, Till, Voigtländer, Lisa, Schaefer, Andreas, Seiffert, Moritz, Pecha, Simon, Schofer, Niklas, Greenbaum, Adam B., Reichenspurner, Hermann, Blankenberg, Stefan, Conradi, Lenard, Schirmer, Johannes
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.12.2021; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Aorta; Aortic valve; Aortic Valve - diagnostic imaging; Aortic Valve - surgery; Aortic Valve Stenosis - surgery; Bioprosthesis - adverse effects; Cardiology; Cathedrals; Computed tomography; Coronary Angiography; Coronary artery; Coronary Occlusion - diagnosis; Coronary Occlusion - prevention & control; Coronary Vessels - diagnostic imaging; Cusps; Degeneration; Echocardiography; Female; Fluoroscopy; Follow-Up Studies; Heart Valve Prosthesis - adverse effects; Heart valves; Humans; Iatrogenic Disease - prevention & control; Implantation; Male; Medicine; Medicine & Public Health; Original Paper; Patients; Postoperative Complications - diagnosis; Postoperative Complications - prevention & control; Prosthesis Design; Retrospective Studies; Risk; Stenosis; Tomography, X-Ray Computed; Transcatheter Aortic Valve Replacement - adverse effects; Transcatheter aortic valve implantation; BASILICA; Coronary obstruction
• ISSN: 1861-0684; 1861-0692; 1861-0692
• DOI: 10.1007/s00392-021-01881-4

Objectives This study aimed to assess the clinical outcome of the bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary obstruction (BASILICA) technique in a single-center patient cohort considered at high or prohibitive risk of transcatheter aortic valve implantation (TAVI)-induced coronary obstruction. Methods Between October 2019 and January 2021, a total of 15 consecutive patients (age 81.0 [78.1, 84.4] years; 53.3% female; EuroSCORE II 10.6 [6.3, 14.8] %) underwent BASILICA procedure prior to TAVI at our institution. Indications for TAVI were degeneration of stented ( n  = 12, 80.0%) or stentless ( n  = 1, 6.7%) bioprosthetic aortic valves, or calcific stenosis of native aortic valves ( n  = 2, 13.3%), respectively. Individual risk of TAVI-induced coronary obstruction was assessed by pre-procedural computed tomography analysis. Procedural and 30-day outcomes were documented in accordance with Valve Academic Research Consortium (VARC)-2 criteria. Results BASILICA was attempted for single left coronary cusp in 12 patients (80.0%), for single right coronary cusp in 2 patients (13.3%), and for both cusps in 1 patient (6.7%), respectively. The procedure was feasible in 13 patients (86.7%) resulting in effective prevention of coronary obstruction, whilst TAVI was performed without prior successful bioprosthetic leaflet laceration in two patients (13.3%). In one of these patients (6.7%), additional chimney stenting immediately after TAVI was performed. No all-cause deaths or strokes were documented after 30 days. Conclusion The BASILICA technique appears to be a feasible, safe and effective concept to avoid iatrogenic coronary artery obstruction during TAVI in both native and bioprosthetic valves of patients at high or prohibitive risk. ClinicalTrials.gov Identifier: NCT04227002 (Hamburg AoRtic Valve cOhoRt).