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Pachyderm-Shape Guiding Catheters to Simplify BASILICA Leaflet Traversal
John C Lisko1, Vasilis C Babaliaros1, Robert J Lederman2
1Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA, USA.
New Pachyderm guiding catheters significantly reduce procedure time for Bioprosthetic Aortic Scallop Intentional Laceration (BASILICA) during TAVR. These custom-shaped catheters are recommended over conventional ones for improved efficiency and patient outcomes.
Area of Science:
- Cardiovascular medicine
- Interventional cardiology
- Medical device innovation
Background:
- Bioprosthetic Aortic Scallop Intentional Laceration (BASILICA) is crucial for preventing coronary obstruction during transcatheter aortic valve replacement (TAVR).
- Conventional guiding catheters present technical challenges for effective BASILICA procedures.
- Novel elephant-trunk shaped Pachyderm guiding catheters (PAL, PJR) are designed to better engage aortic cusp hinge points.
Purpose of the Study:
- To evaluate the efficacy of new custom-shaped Pachyderm guiding catheters in simplifying the BASILICA procedure.
- To compare the procedural efficiency of Pachyderm catheters against conventional coronary guiding catheters used in the BASILICA IDE trial.
Main Methods:
- A retrospective observational cohort study at a single center.
- Patients undergoing BASILICA for TAVR-induced coronary obstruction risk (valve-to-coronary distance <4 mm) were included.
- Procedural data were compared to adjudicated findings from the BASILICA IDE trial.
Main Results:
- Leaflet traversal was universally successful in all nine leaflets across six patients.
- Pachyderm catheters significantly reduced the mean time-to-leaflet traversal (8.3 min) compared to conventional catheters (45 min, p=0.016).
- No deaths, strokes, or vascular complications were reported.
Conclusions:
- The novel Pachyderm guiding catheters substantially decrease procedural time for BASILICA.
- These custom-shaped catheters offer a significant advantage over conventional coronary-shaped guiding catheters for BASILICA procedures.
- The use of Pachyderm catheters is recommended to enhance efficiency in BASILICA TAVR.
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