Key result
BA-BISILICA electrosurgical leaflet laceration may facilitate uniform THV expansion in type 1 bicuspid TAVR.
Why the study?
Sievers type 1 bicuspid aortic valve anatomy with a calcified raphe, eccentric calcification, and elliptical annular geometry can impede complete transcatheter heart valve expansion during TAVR, motivating a stepwise electrosurgical leaflet-laceration technique to optimize deployment.
Transcatheter electrosurgical leaflet laceration (BA-BISILICA) is described as a technique that may facilitate uniform transcatheter heart valve expansion in patients with Sievers type 1 bicuspid aortic valve undergoing TAVR.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“In Sievers type 1 bicuspid aortic valve anatomy, precise raphe targeting and laceration are critical determinants of BA-BISILICA success. BA-BISILICA may have important implications for transcatheter heart valve durability and hemodynamic performance in patients with Sievers type 1 bicuspid aortic valve anatomy undergoing TAVR.”
BA-BISILICA should not yet alter TAVR practice in Sievers type 1 BAV; leaves open the need for prospective validation of raphe laceration.
Objective Sievers type 1 bicuspid aortic valve anatomy, characterized by a calcified raphe, eccentric calcification, and elliptical annular geometry, may impede complete transcatheter heart valve (THV) expansion during transcatheter aortic valve replacement. A stepwise transcatheter electrosurgical leaflet-laceration technique is described to optimize THV deployment. Key Steps Cerebral embolic protection is established. A steerable guiding system is positioned adjacent to the calcified raphe. An electrified guidewire is used to traverse the fused leaflet. Balloon augmentation is performed. A “flying V” rail configuration is created. Electrosurgical raphe laceration is performed. The THV is deployed. Pitfalls Pitfalls include embolization of calcium, difficulty lacerating a heavily calcified raphe, and hemodynamic instability. Technical tips include cerebral embolic protection, precise positioning of the traversal system adjacent to the raphe, balloon dilatation of the traversal channel, and prompt THV deployment. Take-Home Message Transcatheter electrosurgical leaflet laceration may facilitate uniform THV expansion in Sievers type 1 bicuspid aortic valve patients undergoing transcatheter aortic valve replacement.
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SHAHMORADI et al. (2026) studied Sievers type 1 bicuspid aortic valve undergoing transcatheter aortic valve replacement (TAVR). Balloon-Augmented Bicuspid Scallop Intentional Laceration to Induce Circularization of the Aortic Implant (BA-BISILICA) / transcatheter electrosurgical leaflet laceration was evaluated on Uniform transcatheter heart valve (THV) expansion and deployment. Transcatheter electrosurgical leaflet laceration (BA-BISILICA) may facilitate uniform transcatheter heart valve expansion in Sievers type 1 bicuspid aortic valve patients undergoing TAVR.
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