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Updated: Jun 21, 2025

Ablation of Ischemic Ventricular Tachycardia Using a Multipolar Catheter and 3-dimensional Mapping System for High-density Electro-anatomical Reconstruction

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Sustained Intraprocedural Cardiac Arrest During BASILICA TAVR.

Morgan R Casper¹, Garrett Cohen², Benjamin Stripe²

¹Department of Internal Medicine, University of California Davis Medical Center, Sacramento, California, USA.

Journal of the American College of Cardiology

|July 10, 2024

Summary

The BASILICA procedure helps severe aortic stenosis patients undergo TAVR. However, a rare complication can cause cardiac arrest due to coronary artery obstruction.

Keywords:

aortic valve echocardiography myocardial infarction stents systolic heart failure valve replacement

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Area of Science:

Cardiology
Interventional Cardiology
Cardiac Surgery

Background:

Severe aortic stenosis often presents anatomical challenges for transcatheter aortic valve replacement (TAVR).
The BASILICA (bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction) procedure was developed to address these challenges.
BASILICA facilitates TAVR in patients with specific anatomical issues, such as unfavorable leaflet orientation or coronary ostia height.

Observation:

A case report details a patient who underwent a successful BASILICA procedure.
Despite the procedure's success, the patient experienced intraprocedural cardiac arrest.
The cardiac arrest was attributed to iatrogenic left main coronary artery obstruction.

Findings:

The BASILICA procedure, while enabling TAVR in complex cases, carries a risk of coronary artery obstruction.
Iatrogenic left main coronary artery obstruction is a potential, albeit rare, complication following BASILICA.
Prompt recognition and management are crucial for adverse events during or after BASILICA.

Implications:

This case highlights the importance of vigilance for coronary artery obstruction during TAVR with BASILICA.
Further research may be needed to refine BASILICA techniques and minimize complication risks.
Understanding and anticipating such rare complications is vital for improving patient outcomes in complex TAVR cases.