Preventing Coronary Obstruction During Transcatheter Aortic Valve Replacement: Results From the Multicenter International BASILICA Registry
JACC: Cardiovascular Interventions
Objectives: This study sought to determine the safety of the BASILICA (bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction) procedure.
Background: Transcatheter aortic valve replacement causes coronary artery obstruction in 0.7% of cases, with 40% to 50% mortality. BASILICA is a procedure to prevent coronary obstruction. Safety and feasibility in a large patient cohort is lacking.
Methods: The international BASILICA registry was a retrospective, multicenter, real-world registry of patients at risk of coronary artery obstruction undergoing BASILICA and transcatheter aortic valve replacement. Valve Academic Research Consortium-2 definitions were used to adjudicate events.
Results: Between June 2017 and December 2020, 214 patients were included from 25 centers in North America and Europe; 72.8% had bioprosthetic aortic valves and 78.5% underwent solo BASILICA. Leaflet traversal was successful in 94.9% and leaflet laceration in 94.4%. Partial or complete coronary artery obstruction was seen in 4.7%. Procedure success, defined as successful BASILICA traversal and laceration without mortality, coronary obstruction, or emergency intervention, was achieved in 86.9%. Thirty-day mortality was 2.8% and stroke was 2.8%, with 0.5% disabling stroke. Thirty-day death and disabling stroke were seen in 3.4%. Valve Academic Research Consortium-2 composite safety was achieved in 82.8%. One-year survival was 83.9%. Outcomes were similar between solo and doppio BASILICA, between native and bioprosthetic valves, and with the use of cerebral embolic protection.
Conclusions: BASILICA is safe, with low reported rates of stroke and death. BASILICA is feasible in the real-world setting, with a high procedure success rate and low rates of coronary artery obstruction.
Khan, Jaffar M.; Babaliaros, Vasilis C.; Greenbaum, Adam B.; Spies, Christian; Daniels, David; Depta, Jeremiah P.; Oldemeye, J Bradley; Whisenant, Brian; McCabe, James M.; Muhammad, Kamran I.; George, Isaac; Mahoney, Paul; Lanz, Jonas; Laham, Roger J.; Shah, Pinak B.; Chhatriwalla, Adnan; Yazdani, Shahram; Hanzel, George; Pershad, Ashish; Leonardi, Robert A.; Khalil, Ramzi; Tang, Gilbert H L; Herrmann, Howard C.; Agarwal, Shikhar; Fail, Peter S.; Zhang, Ming; Pop, Andrei; Lisko, John; Perdoncin, Emily; Koch, Rachel L.; Ben-Dor, Itsik; Satler, Lowell F.; Zhang, Cheng; Cohen, Jeffrey E.; Lederman, Robert J.; Waksman, Ron; and Rogers, Toby, "Preventing Coronary Obstruction During Transcatheter Aortic Valve Replacement: Results From the Multicenter International BASILICA Registry" (2021). Rochester Regional Health authored publications and proceedings. 167.