Limited-Access Zero-Contrast BASILICA Transcatheter Aortic Valve Replacement

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Imaging

Background:

• Transcatheter aortic valve replacement (TAVR) can be challenging in patients with severe anaphylactic reactions to contrast agents, limited vascular access, and high risk of coronary artery occlusion.
• The BASILICA (Balloon-Assisted Severe Coronary Intervention Access) technique is an option for complex TAVR cases, but its application in patients with contraindications to contrast agents and limited access requires careful planning.

Observation:

• This report details a unique TAVR case involving a patient with anaphylaxis to intra-arterial contrast agents, single femoral access limitations, and high coronary artery occlusion risk.
• The procedure successfully utilized a modified BASILICA technique without intra-arterial contrast agents, employing computed tomography (CT), fluoroscopy, and trans-esophageal echocardiography (TEE) for guidance.

Findings:

• A zero-contrast agent BASILICA approach was successfully implemented, overcoming significant patient-specific challenges.
• Multimodality imaging, including CT for orthogonal angle acquisition, fluoroscopy, and TEE, was essential for guiding the procedure and ensuring safety.
• A single coronary wire placed at the noncoronary cusp served as a marker, simplifying TAVR deployment and negating the need for multiple pigtail catheters.

Implications:

• This case highlights the feasibility of a limited-access, zero-contrast BASILICA TAVR in high-risk patients, expanding treatment options.
• The findings underscore the critical role of advanced imaging techniques in navigating complex interventional cardiovascular procedures.
• This approach may offer a viable alternative for patients who would otherwise be ineligible for standard TAVR procedures due to contrast allergies or anatomical constraints.