BASILICA-assisted TAVI: when leaflet laceration takes an unexpected turn

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Symptomatic severe aortic stenosis (n=1). Intervention: BASILICA-assisted transcatheter aortic valve implantation (TAVI). Primary outcome: Procedural success and complications (annular and myocardial perforation leading to pericardial tamponade).

Q: What does this research mean for the field?

Suboptimal wire trajectory during BASILICA-assisted TAVI can cause annular and myocardial perforation, resulting in cardiac tamponade following valve expansion. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Paul T.L. Chiam; Choon Pin Lim; Kok Soon Tan; Cumaraswamy Sivathasan

doi:10.4244/aij-d-26-00028

October 1, 2026AsiaInterventionOpen Access

BASILICA-assisted TAVI: when leaflet laceration takes an unexpected turn

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Why the study?

In a patient with severe aortic stenosis, a low left coronary height, and a long thickened left coronary cusp, BASILICA-assisted TAVI was planned to minimize the risk of left coronary occlusion and preserve future coronary access.

Key Points

To report a life-threatening complication of annular and left ventricular myocardial perforation during BASILICA-assisted transcatheter aortic valve implantation (TAVI).
Clinical case evaluation of a 75-year-old male with symptomatic severe aortic stenosis and high risk of coronary obstruction undergoing BASILICA prior to balloon-expandable TAVI.
An electrified Astato XS 20 wire inside a PiggyBack microcatheter and an 8 Fr Amplatz left 2 guide catheter was directed at the left coronary cusp to lacerate the leaflet before deploying a 26 mm SAPIEN 3 Ultra valve.
Initial electrified wire traversal advanced laterally, causing mild left ventricular myocardial staining before a second attempt with a 45° distal wire bend crossed into the left ventricular outflow tract to complete leaflet laceration.
Following 26 mm SAPIEN 3 Ultra valve deployment, acute hypotension developed due to pericardial tamponade and contrast extravasation into the pericardial space.
Surgical exploration identified a perforation originating at the base of the left coronary cusp extending through the annulus into the left ventricular myocardium, which was successfully repaired under ECMO support that was discontinued 1 week later.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

A 75-year-old male with symptomatic severe aortic stenosis, low left coronary height (7.7 mm), and intermediate surgical risk undergoing BASILICA-assisted TAVI.

I

Intervention

Transcatheter aortic valve implantation (TAVI) using a 26 mm SAPIEN 3 Ultra balloon-expandable valve without predilatation, assisted by bioprosthetic aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction (BASILICA) using an electrified Astato XS 20 wire via an 8 Fr Amplatz left 2 guide catheter and PiggyBack microcatheter, with concurrent left coronary protection.

O

Outcome

Procedural complication: perforation originating at the base of the left coronary cusp extending through the annulus and into the left ventricular myocardium, resulting in pericardial tamponade requiring pericardiocentesis, extracorporeal membrane oxygenation (ECMO), and open surgical repair and valve replacement.safety

Limitations

Suboptimal guide catheter and wire trajectory using an oversized AL2 guide catheter without a smaller inner curved catheter
Continuation of valve implantation immediately following an initial 0.014 inch wire injury to the myocardium

Implication

This case report highlights that during BASILICA-assisted TAVI, proper wire trajectory toward the center of the LVOT is critical, and if annular or myocardial wire injury occurs, valve implantation should be aborted until the injury heals to prevent catastrophic perforation and tamponade.

Abstract

Venous cannula Right atriumThe white arrow shows the perforation after removal of the left coronary leaflet.

Discussion

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Cite This Study

Chiam et al. (2026) conducted a case report in Symptomatic severe aortic stenosis (n=1). BASILICA-assisted transcatheter aortic valve implantation (TAVI) was evaluated on Procedural success and complications (annular and myocardial perforation leading to pericardial tamponade).

synapsesocial.com/papers/6adfeb2da8f7ee114eb18210 https://doi.org/10.4244/aij-d-26-00028

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BASILICA-assisted TAVI: when leaflet laceration takes an unexpected turn

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

BASILICA-assisted TAVI: when leaflet laceration takes an unexpected turn

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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