Preventing Coronary Obstruction During Transcatheter Aortic Valve Replacement Results From the Multicenter International BASILICA Registry

OBJECTIVES This study sought to determine the safety of the BASILICA (bioprosthetic or native aortic scallop inten-tional laceration to prevent iatrogenic coronary artery obstruction) procedure. BACKGROUND Transcatheter aortic valve replacement causes coronary artery obstruction in 0.7% of cases, with 40% to 50% mortality. BASILICA is a procedure to prevent coronary obstruction. Safety and feasibility ina large patient cohort is lacking. METHODS The international BASILICA registry was a retrospective, multicenter, real-world registry of patients at risk of coronary artery obstruction undergoing BASILICA and transcatheter aortic valve replacement. Valve Academic Research Consortium-2 definitions were used to adjudicate events. RESULTS Between June 2017 and December 2020, 214 patients were included from 25 centers in North America and Europe; 72.8% had bioprosthetic aortic valves and 78.5% underwent solo BASILICA. Leaflet traversal was successful in 94.9% and leaflet laceration in 94.4%. Partial or complete coronary artery obstruction was seen in 4.7%. Procedure success, defined as successful BASILICA traversal and laceration without mortality, coronary obstruction, or emergency intervention, was achieved in 86.9%. Thirty-day mortality was 2.8% and stroke was 2.8%, with 0.5% disabling stroke. Thirty-day death and disabling stroke were seen in 3.4%. Valve Academic Research Consortium-2 composite safety was achieved in 82.8%. One-year survival was 83.9%. Outcomes were similar between solo and doppio BASILICA, between native and bioprosthetic valves, and with the use of cerebral embolic protection. CONCLUSIONS BASILICA is safe, with low reported rates of stroke and death. BASILICA is feasible in the real-world setting, with a high procedure success rate and low rates of coronary artery obstruction. (J Am Coll Cardiol Intv 2021;14:941-8) (c) 2021 the American College of Cardiology Foundation. Published by Elsevier. All rights reserved.

Automated summary

The BASILICA procedure is safe with low rates of stroke and death. It is feasible in a real-world setting, with high procedure success rate and low rates of coronary artery obstruction.