Modification of Calcified Native and Surgical Bioprosthetic Aortic Valves

Lucca Loretz; Colin Jamieson; Edward Quine; Gabriel Saad; Alison Kane; Brooke MacLeod; Sheryl Munshan; Desiree Wussler; Vasilis Babaliaros; Dr Adam Greenbaum; Toby Rogers; Micheal A. Seidman; Ole De Backer; James M. McCabe; John G. Webb; David A. Wood; Philipp Blanke; David Meier; Jaffar M. Khan; Stephanie L. Sellers

doi:10.1016/j.jcin.2026.05.005

Key result

Leaflet modification proves feasible across calcific aortic valves but efficacy varies by specific valve features.

Graphical abstract published by JACC: Cardiovascular Interventions — Graphical abstract · Published by JACC: Cardiovascular Interventions · CC BY 4.0

Why the study?

Is leaflet modification (BASILICA or intraleaflet deployment) feasible and effective in calcific native and bioprosthetic surgical aortic valves?

Key Points

This study aims to assess leaflet modification techniques in native and surgical bioprosthetic aortic valves.
Benchtop assessment of calcific native aortic valves (n=100) and 7 types of surgical aortic valves.
Modification of calcific native cusps (n=13) and SAV leaflets (n=14) by electrosurgical or mechanical BASILICA and intraleaflet deployment.
Evaluation of splay, laceration patterns, and embolic debris, analyzing impacts of leaflet length and valve-in-valve implantation.
Leaflet modification techniques were generally feasible across different calcific disease severity.
Splay area increased with simulated valve expansion, variability observed across surgical aortic valve types.
Impacts of native valve and SAV features significantly influenced the effectiveness of leaflet modifications.

Structured PICO

Is leaflet modification (BASILICA or intraleaflet deployment) feasible and effective in calcific native and bioprosthetic surgical aortic valves?

P

Population

Calcific native aortic valves (n=100), naive surgical aortic valves (SAVs, 7 types), calcific native cusps (n=13), and SAV leaflets (n=14) stratified by calcific load.

I

Intervention

Leaflet modification by electrosurgical or mechanical BASILICA (bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction) or intraleaflet deployment.

O

Outcome

Splay, laceration patterns, and embolic debris.surrogate

Benchtop assessment demonstrates that leaflet modification techniques like BASILICA are feasible across a spectrum of calcific disease in native and bioprosthetic aortic valves.

Implication

Bench findings on splay variation warrant clinical caution; leaves open optimal SAV selection for leaflet modification in vivo.

Abstract

BACKGROUND: Leaflet modification (LM) techniques, including electrosurgical and mechanical BASILICA (bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction) and intraleaflet deployment, are important in the lifetime management of aortic valve disease. However, benchtop assessment is limited. OBJECTIVES: The aim of this study was to provide a benchtop assessment of LM in native valves and bioprosthetic surgical aortic valves (SAVs). METHODS: Features of calcific native aortic valves (n = 100) and naive SAVs (7 types) were assessed. Calcific native cusps (n = 13) and SAV leaflets (n = 14) stratified by calcific load were modified by electrosurgical or mechanical BASILICA or intraleaflet deployment with assessment of splay, laceration patterns, and embolic debris. The impact of leaflet length and valve-in-valve implantation on splay area was analyzed. RESULTS: = 0.84) and generally increased with simulated valve expansion, but this varied by SAV type. CONCLUSIONS: Features of native aortic valves and SAVs impact the efficacy of LM. LM is feasible across a spectrum of calcific disease. Further study is required.

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Cite This Study

Loretz et al. (2026) studied this question. Leaflet modification is feasible across a spectrum of calcific disease in native and surgical bioprosthetic aortic valves, although its efficacy is impacted by specific valve features.

synapsesocial.com/papers/6a3c2375d15afadd906fa302 https://doi.org/10.1016/j.jcin.2026.05.005

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Modification of Calcified Native and Surgical Bioprosthetic Aortic Valves

Key Points

Structured PICO

Implication

Abstract

Discussion

Cite This Study

Modification of Calcified Native and Surgical Bioprosthetic Aortic Valves

Key Points

Structured PICO

Implication

Abstract

Discussion

Cite This Study

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