Ultrasound Imaging Integration to Prevent Coronary Obstruction During Valve-In-Valve Transcatheter Aortic Valve...

Transcatheter aortic valve-in-valve implantation (TAVI-VIV) in degenerated surgical aortic bioprosthesis is a treatment option in patients with high surgery risk. Some surgical bioprosthesis have a high-risk of coronary artery occlusion (CAO), which is one of the most dreadful complications of TAVI-VIV procedures. Two main techniques such as Bioprosthetic or native Aortic Scallop Intentional Laceration to prevent Iatrogenic Coronary Artery obstruction (BASILICA) and Shortcut (Pi-Cardia, Rehovot, Israel) are used to split the bioprosthetic leaflet to prevent CAO. In this Viewpoint we discuss the role of transesofageal echocardiography and intracardiac ultrasound in guiding and detecting complications during leaflet splitting. We also propose a classification of different scenarios regarding leaflet splitting success and coronary ostia position in relation to target bioprosthetic leaflet.