Preventing Coronary Obstruction During Transcatheter Aortic Valve Replacement: From Computed Tomography to BASILICA

Area of Science:

• Cardiovascular Interventions
• Structural Heart Disease
• Interventional Cardiology

Background:

• Coronary artery obstruction is a rare but severe complication following transcatheter aortic valve replacement (TAVR).
• Existing preventive methods like snorkel stenting have significant limitations and complications.
• There is a need for effective strategies to mitigate this risk.

Purpose of the Study:

• To review the prediction and prevention of TAVR-associated coronary artery obstruction.
• To provide guidance on utilizing the Bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction (BASILICA) technique.
• To summarize current understanding and procedural aspects of BASILICA.

Main Methods:

• Review of pathophysiological mechanisms of TAVR-related coronary obstruction.
• Step-by-step analysis of pre-procedural computed tomography for risk assessment and BASILICA planning.
• Description of transcatheter electrosurgery principles.
• Detailed procedural guidance for performing BASILICA.

Main Results:

• Computed tomography is sensitive but not specific for predicting coronary obstruction.
• The BASILICA technique aims to prevent obstruction by creating space for coronary flow.
• Early and late ischemic complications are concerns with other transcatheter approaches.

Conclusions:

• BASILICA represents a promising, albeit early-stage, transcatheter approach to prevent coronary artery obstruction during TAVR.
• Careful pre-procedural assessment and procedural technique are crucial for successful BASILICA implementation.
• Further research and experience are needed given the technique's infancy.