Objectives: Iatrogenic coronary artery obstruction during TAVI, directly or by sequestering the sinus of Valsalva at the sinotubular junction, is a rare but threatening complication. We aimed to evaluate feasibility, safety and early clinical outcome of BASILICA technique in a single center patient cohort considered at high or prohibitive risk of TAVI-induced coronary artery obstruction.
Methods: Between October 2019 and August 2020, a total of 12 consecutive patients (age: 79 ± 8 years, 50% female, logEuroSCORE: 20.2 ± 11.6%) underwent BASILICA procedure immediately before TAVI at our institution. Indications for TAVI were degeneration of stented (n = 9) or stentless (n = 1) bioprosthetic aortic valves, or symptomatic calcific stenosis of native aortic valves (n = 2), respectively. Individual risk for TAVI-induced coronary artery obstruction was assessed by multislice computed tomography analysis. Procedural setup routinely included cerebral embolic protection device insertion.
Result: BASILICA was performed for single left coronary leaflet in 9 (75%) patients, for single right coronary leaflet in two (17%) patients, and for both leaflets in one (8%) patient. BASILICA procedure was feasible in 10 (83%) patients resulting in effective prevention of coronary artery obstruction, while TAVI had to be performed without prior successful bioprosthetic leaflet laceration in two (17%) patients. In one (8%) of these patients, additional ostial coronary stenting was necessary. No deaths or strokes were documented until 30 days. One (8%) major vascular complication related to TAVI but not BASILICA was registered.
Conclusion: BASILICA technique appears to be a feasible and effective concept to avoid iatrogenic coronary artery obstruction during TAVI in both native and bioprosthetic valves of patients at high risk. However, further studies in a larger patient population seem to be required.
