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Open Access 01-12-2021 | Transcatheter Aortic Valve Implantation | Original Paper

Prevention of coronary obstruction in patients at risk undergoing transcatheter aortic valve implantation: the Hamburg BASILICA experience

Authors: Dirk Westermann, Sebastian Ludwig, Daniel Kalbacher, Clemens Spink, Matthias Linder, Oliver D. Bhadra, Julius Nikorowitsch, Lara Waldschmidt, Till Demal, Lisa Voigtländer, Andreas Schaefer, Moritz Seiffert, Simon Pecha, Niklas Schofer, Adam B. Greenbaum, Hermann Reichenspurner, Stefan Blankenberg, Lenard Conradi, Johannes Schirmer

Published in: Clinical Research in Cardiology | Issue 12/2021

Abstract

Objectives

This study aimed to assess the clinical outcome of the bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary obstruction (BASILICA) technique in a single-center patient cohort considered at high or prohibitive risk of transcatheter aortic valve implantation (TAVI)-induced coronary obstruction.

Methods

Between October 2019 and January 2021, a total of 15 consecutive patients (age 81.0 [78.1, 84.4] years; 53.3% female; EuroSCORE II 10.6 [6.3, 14.8] %) underwent BASILICA procedure prior to TAVI at our institution. Indications for TAVI were degeneration of stented (n = 12, 80.0%) or stentless (n = 1, 6.7%) bioprosthetic aortic valves, or calcific stenosis of native aortic valves (n = 2, 13.3%), respectively. Individual risk of TAVI-induced coronary obstruction was assessed by pre-procedural computed tomography analysis. Procedural and 30-day outcomes were documented in accordance with Valve Academic Research Consortium (VARC)-2 criteria.

Results

BASILICA was attempted for single left coronary cusp in 12 patients (80.0%), for single right coronary cusp in 2 patients (13.3%), and for both cusps in 1 patient (6.7%), respectively. The procedure was feasible in 13 patients (86.7%) resulting in effective prevention of coronary obstruction, whilst TAVI was performed without prior successful bioprosthetic leaflet laceration in two patients (13.3%). In one of these patients (6.7%), additional chimney stenting immediately after TAVI was performed. No all-cause deaths or strokes were documented after 30 days.

Conclusion

The BASILICA technique appears to be a feasible, safe and effective concept to avoid iatrogenic coronary artery obstruction during TAVI in both native and bioprosthetic valves of patients at high or prohibitive risk.

ClinicalTrials.gov Identifier: NCT04227002 (Hamburg AoRtic Valve cOhoRt).

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Title: Prevention of coronary obstruction in patients at risk undergoing transcatheter aortic valve implantation: the Hamburg BASILICA experience
Authors: Dirk Westermann
Sebastian Ludwig
Daniel Kalbacher
Clemens Spink
Matthias Linder
Oliver D. Bhadra
Julius Nikorowitsch
Lara Waldschmidt
Till Demal
Lisa Voigtländer
Andreas Schaefer
Moritz Seiffert
Simon Pecha
Niklas Schofer
Adam B. Greenbaum
Hermann Reichenspurner
Stefan Blankenberg
Lenard Conradi
Johannes Schirmer
Publication date: 01-12-2021
Publisher: Springer Berlin Heidelberg
Keyword: Transcatheter Aortic Valve Implantation
Published in: Clinical Research in Cardiology / Issue 12/2021
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-021-01881-4

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Prevention of coronary obstruction in patients at risk undergoing transcatheter aortic valve implantation: the Hamburg BASILICA experience

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Conclusion

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