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

Systematic use of intentional leaflet laceration to prevent TAVI-induced coronary obstruction: feasibility and early clinical outcomes of the BASILICA technique

DOI: 10.4244/EIJ-D-20-00386

1. Herzzentrum Leipzig Universitatsklinik, Department of Structural Heart Disease / Cardiology, Leipzig, Germany
2. Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
3. Department of Structural Heart Disease/Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
4. Department of Structural Heart Disease/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
5. Department of Structural Heart Disease/Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Department of Cardiac Surgery, University of Jordan, Amman, Jordan
6. Department of Diagnostic and Interventional Radiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
7. Department of Anaesthesiology and Intensive Care Medicine, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
8. Department of Cardiology, University of Washington Medical Center, Seattle, USA
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Aims: To evaluate the feasibility, efficacy and safety of the bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction (BASILICA) technique during transcatheter aortic valve implantation (TAVI) in an initial cohort at a single European centre. 

Methods and results: Between August 2018 and March 2020, BASILICA was attempted in 23 leaflets in 21 consecutive patients undergoing TAVI (age 78 ± 6 years, 52% women). The index procedure was performed for 21 degenerated bioprosthetic leaflets (90%, 9.2 ± 2.6 years after implantation) and 2 native leaflets (10%). BASILICA was performed for a single leaflet in 19 (90%) patients and for both leaflets in 2 (10%) patients. The median total procedure time was 82 (interquartile range [IQR] 70 – 131) min, and BASILICA time (sheath-in to laceration) was 45 (IQR 35 – 67) min. A cerebral embolic protection device was used in 20 (95%) patients. 

BASILICA was feasible in all but one patient (95%) and resulted in effective prevention of coronary obstruction in 19 patients (90%). One patient developed a non-flow-limiting ostial lesion after BASILICA and TAVI and was treated by additional coronary stenting. No mortality or stroke were observed until 30 days.

Conclusions: The feasibility, efficacy and safety of BASILICA in this early single-centre experience was consistent with the initial proof-of-concept reports. Further validation by ongoing multicentre registries remains warranted.

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