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Modification of Calcified Native and Surgical Bioprosthetic Aortic Valves: Lessons From the Bench
Lucca Loretz1, Colin Jamieson2, Edward Quine2
1Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada; Centre for Heart Valve Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada.
JACC. Cardiovascular Interventions
|June 22, 2026
Summary
Leaflet modification techniques are feasible for aortic valve disease, but calcification impacts difficulty and debris. Valve features influence leaflet splay during these procedures.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Biomaterials Science
Background:
- Leaflet modification (LM) techniques are crucial for managing aortic valve disease throughout a patient's life.
- Techniques include electrosurgical and mechanical BASILICA (bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction) and intraleaflet deployment.
- Current benchtop assessment methods for LM are limited.
Purpose of the Study:
- To conduct a benchtop assessment of leaflet modification techniques in native aortic valves and bioprosthetic surgical aortic valves (SAVs).
Main Methods:
- Assessed features of 100 calcific native aortic valves and 7 types of naive SAVs.
- Modified calcific native cusps and SAV leaflets using electrosurgical or mechanical BASILICA or intraleaflet deployment.
- Evaluated leaflet splay, laceration patterns, and embolic debris, analyzing the impact of leaflet length and valve-in-valve implantation on splay area.
Main Results:
- Calcification was prevalent in native aortic valve cusps, affecting traversal and laceration zones.
- LM feasibility varied with calcification severity, with higher calcification linked to increased difficulty, tears, and debris.
- Leaflet splay was reduced by shorter leaflet length and influenced by simulated valve expansion, with variations across SAV types.
Conclusions:
- Native aortic valve and SAV characteristics significantly influence the effectiveness of leaflet modification.
- Leaflet modification is achievable across various degrees of calcific aortic disease.
- Further research is necessary to fully understand and optimize LM techniques.
