Key result
The BASILICA technique during high-risk TAVR achieved a 90.9% procedural success rate, with a 7% coronary obstruction rate and 2.1% 30-day/in-hospital mortality across 384 patients.
Why the study?
Coronary artery obstruction is a serious complication of TAVR, and the efficacy and safety of the BASILICA leaflet laceration technique developed to prevent it in high-risk patients warranted a literature review.
Does the BASILICA technique achieve procedural success and prevent coronary artery obstruction in high-risk individuals undergoing TAVR?
Systematic Review (n=384)
Does the BASILICA technique achieve procedural success and prevent coronary artery obstruction in high-risk individuals undergoing TAVR?
In experienced hands, the BASILICA technique demonstrates a 90.9% procedural success rate and a 2.1% 30-day/in-hospital mortality rate, making it a reasonable option to prevent coronary obstruction in high-risk TAVR patients.
Coronary artery obstruction is an uncommon but serious complication of transcatheter aortic valve replacement (TAVR) with significant morbidity and mortality. Transcatheter electrosurgical aortic leaflet laceration (Bioprosthetic or Native Aortic Scallop Intentional Laceration to Prevent Iatrogenic Coronary Artery Obstruction [BASILICA]) was developed to prevent coronary artery obstruction in suitable individuals at high-risk of coronary obstruction undergoing TAVR. This study aims to evaluate the efficacy and safety of the BASILICA technique by performing a review of the available literature. A literature search for relevant studies till August 2024 was undertaken. Procedural success was defined as successful leaflet traversal and laceration. Safety outcomes included mortality (cardiovascular and non-cardiovascular), stroke, coronary artery obstruction, major vascular complications, life-threatening bleeds, acute kidney injury or valve-related complications requiring further procedures. 9 observational studies involving 384 patients were included. 303 were single BASILICA while 81 were doppio BASILICA procedures; 81 involved the native aortic valve, while 303 involved bioprosthetic aortic valves. 16 patients had balloon-augmented BASILICA. The overall procedure success rate was 90.9% (349/384). The potential/definite coronary obstruction rate was 7% (27/384). 6.7% (25/372) required subsequent percutaneous coronary intervention and 0.9% (2/235) required snaring of initial TAVR valve into the ascending aorta and deployment of a second valve. The 30-day/in-hospital mortality rate was 2.1% (8/384). None required emergency open-heart surgery and 1.3% (4/311) required mechanical circulatory support. In experienced hands, BASILICA is a reasonable and potentially valuable alternative in appropriately selected individuals at high risk of coronary obstruction undergoing TAVR.
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Tan et al. (2026) conducted a systematic review in Patients undergoing transcatheter aortic valve replacement (TAVR) at high risk of coronary artery obstruction (n=384). BASILICA (Bioprosthetic or Native Aortic Scallop Intentional Laceration to Prevent Iatrogenic Coronary Artery Obstruction) was evaluated on Procedural success (successful leaflet traversal and laceration). The BASILICA technique during high-risk TAVR achieved a 90.9% procedural success rate, with a 7% coronary obstruction rate and 2.1% 30-day/in-hospital mortality across 384 patients.
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