Sustained Intraprocedural Cardiac Arrest During BASILICA TAVR

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.