Title

Preventing Coronary Obstruction During Transcatheter Aortic Valve Replacement: Results From the Multicenter International BASILICA Registry

Authors

Jaffar M. Khan, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
Vasilis C. Babaliaros, Emory University Hospital, Atlanta, Georgia
Adam B. Greenbaum, Emory University Hospital, Atlanta, Georgia
Christian Spies, BASH-Sutter Health, San Francisco, California
David Daniels, BASH-Sutter Health, San Francisco, California
Jeremiah P. Depta, Sands Constellation Heart Institute, Rochester Regional Health, Rochester, New York
J Bradley Oldemeye, Medical Center of the Rockies, Loveland, Colorado
Brian Whisenant, Intermountain Medical Center, Salt Lake City, Utah
James M. McCabe, University of Washington, Seattle, Washington
Kamran I. Muhammad, Oklahoma Heart Institute, Tulsa, Oklahoma
Isaac George, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York
Paul Mahoney, Sentara Heart Hospital, Norfolk, Virginia
Jonas Lanz, Bern University Hospital, Bern, Switzerland
Roger J. Laham, Beth Israel Deaconess Medical Center, Boston, Massachusetts
Pinak B. Shah, Brigham and Women's Hospital, Boston, Massachusetts
Adnan Chhatriwalla, St. Luke's Hospital of Kansas City, Kansas City, Missouri
Shahram Yazdani, Carient Heart and Vascular, Manassas, Virginia
George Hanzel, Beaumont Hospital, Royal Oak, Michigan
Ashish Pershad, Banner University Medical Center, Phoenix, Arizona
Robert A. Leonardi, Lexington Medical Center, West Columbia, South Carolina
Ramzi Khalil, Allegheny General Hospital, Pittsburgh, Pennsylvania
Gilbert H L Tang, Mount Sinai Hospital, New York, New York
Howard C. Herrmann, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
Shikhar Agarwal, Geisinger Medical Center, Danville, Pennsylvania
Peter S. Fail, Cardiovascular Center of the South, Houma, Louisiana
Ming Zhang, Swedish Medical Center, Seattle, Washington
Andrei Pop, Alexian Brothers Medical Center, Elk Grove Village, Illinois
John Lisko, Emory University Hospital, Atlanta, Georgia
Emily Perdoncin, Emory University Hospital, Atlanta, Georgia
Rachel L. Koch, Emory University Hospital, Atlanta, Georgia
Itsik Ben-Dor, MedStar Washington Hospital Center, Washington, DC
Lowell F. Satler, MedStar Washington Hospital Center, Washington, DC
Cheng Zhang, MedStar Washington Hospital Center, Washington, DC
Jeffrey E. Cohen, MedStar Washington Hospital Center, Washington, DC
Robert J. Lederman, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
Ron Waksman, MedStar Washington Hospital Center, Washington, DC
Toby Rogers, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland

Department

Cardiology

Document Type

Article

Publication Title

JACC: Cardiovascular Interventions

Abstract

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.

DOI

10.1016/j.jcin.2021.02.035

Publication Date

5-10-2021

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