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Related Concept Videos

Mitral Stenosis III: Medical Management01:26

Mitral Stenosis III: Medical Management

Mitral stenosis, a condition marked by the narrowing of the mitral valve, necessitates an integrated approach for effective management. This approach includes preventative measures, medical therapy, and surgical interventions to reduce symptoms and prevent complications.PreventionPrevention of mitral stenosis primarily focuses on reducing the incidence of bacterial infections, particularly streptococcal infections, which can lead to rheumatic fever and subsequent valvular damage. Timely...
Aortic Regurgitation III: Medical Management01:25

Aortic Regurgitation III: Medical Management

Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
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Mitral Valve Prolapse II: Assessment and Management

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Aortic Regurgitation IV: Nursing Management01:17

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Heart Valves01:16

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Updated: Jun 11, 2026

Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
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Aortic Valve Leaflet Modification: A Working Group Position Statement on Best Practices and Step-by-Step Guide.

Toby Rogers1, Rim N Halaby2, Adam B Greenbaum3

  • 1Medstar Washington Hospital Center and Georgetown University, Washington, District of Columbia, USA; Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.

JACC. Cardiovascular Interventions
|June 9, 2026
PubMed
Summary

Bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction (BASILICA) prevents coronary obstruction during transcatheter aortic valve replacement (TAVR). This review offers guidance on BASILICA techniques to improve operator proficiency.

Keywords:
BASILICAcomputed tomographycoronary artery obstructionleaflet modificationtranscatheter aortic valve replacementtranscatheter electrosurgery

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Devices

Background:

  • Coronary artery obstruction is a serious complication of transcatheter aortic valve replacement (TAVR).
  • Preprocedural computed tomography can identify obstruction risk.
  • Bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction (BASILICA) is an effective preventative technique.

Purpose of the Study:

  • To provide contemporary best-practice guidance for BASILICA and related leaflet modification strategies.
  • To synthesize international experience and address barriers to BASILICA adoption.
  • To enhance operator proficiency in preventing TAVR-induced coronary obstruction.

Main Methods:

  • State-of-the-art review of international experience with BASILICA.
  • Detailed explanation of transcatheter electrosurgery principles.
  • Guidance on risk assessment using computed tomography and procedural planning.
  • Step-by-step procedural guide for electrosurgical BASILICA.
  • Discussion of uncommon challenges, limitations, and variant techniques.

Main Results:

  • BASILICA effectively prevents TAVR-induced coronary obstruction.
  • Technical complexity and limited training have hindered BASILICA adoption.
  • The review provides comprehensive guidance on risk analysis, planning, and execution of BASILICA.
  • Variant techniques and strategies for challenging scenarios are presented.

Conclusions:

  • Contemporary best practices for BASILICA can improve operator proficiency.
  • Addressing technical complexity and training needs is crucial for wider adoption.
  • BASILICA and related techniques offer a vital solution for preventing coronary obstruction during TAVR.