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Protocol for Relative Hydrodynamic Assessment of Tri-leaflet Polymer Valves
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Do Not BASILICA the New Valve.

Jonathan X Fang1, Pedro A Villablanca2

  • 1Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA; National Heart Centre Singapore, Singapore.

JACC. Case Reports
|June 6, 2025
PubMed
Summary
This summary is machine-generated.

Bioprosthetic or native Aortic Scallop Intentional Laceration to prevent Iatrogenic Coronary Artery obstruction (BASILICA) is a complex procedure. A new complication involves transcatheter heart valve damage when a valve is pre-positioned before leaflet laceration.

Keywords:
aortic valvecomplicationvalve replacement

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Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Medical Device Technology

Background:

  • Bioprosthetic or native Aortic Scallop Intentional Laceration to prevent Iatrogenic Coronary Artery obstruction (BASILICA) is the standard for leaflet modification in transcatheter aortic valve replacement (TAVR) to prevent coronary obstruction.
  • The BASILICA technique involves wire traversal, snaring, and leaflet laceration using a specialized wire configuration known as the flying V.
  • Careful planning and technical expertise are crucial for successful BASILICA procedures.

Observation:

  • A novel complication of BASILICA is reported, involving inadvertent damage to the transcatheter heart valve (THV) when it was pre-positioned before leaflet laceration.
  • This complication arose from the wire inadvertently crossing between the flying V and the aortic cusp when the flying V was not adequately apposed.
  • Pre-positioning the THV, a variation for high-risk patients, led to this adverse outcome.

Findings:

  • Difficulty visualizing the wire and flying V position can occur, especially in patients with larger body habitus.
  • Operators must confirm the flying V is at cusp level before crossing the aortic valve with a wire.
  • Ensuring the flying V is well apposed to the leaflet before ventricular crossing is vital to prevent complications.

Implications:

  • BASILICA is a complex procedure requiring operator familiarity with potential pitfalls and bailout strategies.
  • Pre-positioning of a THV before BASILICA leaflet laceration is generally unnecessary and should only be pursued with strong clinical justification.
  • Enhanced visualization and meticulous technique are essential to mitigate risks associated with BASILICA, particularly concerning THV integrity.