The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Assessing the risk for coronary obstruction after transcatheter aortic valve implantation and the need to perform BASILICA: the VIVID classification

DOI: 10.4244/EIJ-D-20-00067

1. Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York
2. St. Luke's International Hospital, Cardiology, chuuouku, Tokyo, Japan, Japan
3. Institute of Valvular Research, USA
4. Institute of Valvular Research, USA; Escola Paulista de Medicina – Universidade Federal de São Paulo, São Paulo, Brazil
5. Shaarei Tzdek Medical Centre, Jerusalem, Hebrew University
6. St. Paul’s Hospital, Vancouver, Canada
7. Institue of Vascular Research, USA; Shaarei Tzdek Medical Center, Jerusalem, Hebrew University; University of Washington, Seattle, WA, USA, United States

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The risk for coronary obstruction after TAVI (Transcatheter Aortic Valve Implantation) is high in cases where a deflected failing aortic valve leaflet is positioned in close proximity to a coronary ostium [1,2]. BASILICA (Bioprosthetic or native Aortic Scallop Intentional Laceration to prevent Iatrogenic Coronary Artery obstruction) is a novel technique in which splitting of that aortic valve leaflet can reduce that risk [3]. Although multidetector computed tomography (MDCT) and aortic root angiography are the primary imaging modalities to evaluate the anatomic relationship between the aortic valve and the coronary ostia to determine that risk, no systematic classification exists to determine if coronary obstruction risk is elevated and whether preventive techniques, such as BASILICA,  could be of benefit. VIVID (Valve-in-Valve International Data) registry investigators convened in Paris, France in May 2019 in response to a need for standardization.  We propose here a simplified classification that may guide operators on the risk for coronary obstruction during TAVI and the possible need for BASILICA. Each coronary artery ostium would need to be evaluated, and subsequently classified, separately.

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