Prevention of coronary occlusions during transcatheter aortic valve-in-valve implantation using the BASILICA technique

Abstract

To the Editor, Coronary occlusion is a more common complication after transcatheter aortic valve-in-valve implantation than after transcatheter aortic valve implantation over the native valve. It is due to the displacement of the veil of the surgical valve prior to transcatheter aortic valve implantation until occluding the coronary ostium.1 The risk is higher with surgical prostheses without stent and with those with veils mounted outside the stent. It also depends on the height of coronary ostia and width of sinuses.2 Coronary arteries can be protected by advancing a guidewire or even a stent inside the coronary artery at risk, which creates some sort of chimney to keep the ostium open3 with unpredictable results especially in the long-term. Recently, the BASILICA technique (Bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction) has been described to avoid coronary occlusions. It consists of lacerating the veil of the surgical prosthesis facing the ostium at risk with an electrified guidewire so that it opens when implanting the new prosthesis while leaving the ostium uncovered.4 This is the case of an 89-year-old woman—carrier of a 19 mm Mitroflow bioprosthesis (Sorin Group Inc., Mitroflow Division; Vancouver, Canada) due to severe aortic stenosis since 2010—who was admitted...