BASILICA Technique: Why, When and How?
Three technique-focused papers signal where operators are spending their cognitive load: a Radiology: Cardiothoracic Imaging review on preprocedural CT for redo TAVR, a European Cardiology review of BASILICA , and a Future Cardiology review of direct TAVI vs predilatation .
All three are downstream consequences of the ESC 2025 lifetime-management mandate: coronary access, valve-in-valve feasibility, and commissural alignment must be planned at the index procedure.
ESC 2025 still recommends SAVR for patients under 70 with low surgical risk (Class I); ACC/AHA 2020 holds the line at under 65.
Coronary artery obstruction is a commonly fatal complication occurring after transcatheter aortic valve replacement. The main mechanisms are displacement of valve leaflets to overlie the coronary ostium or sequestration of the coronary sinus. The bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction (BASILICA) procedure mitigates this risk. It entails deliberate laceration of the valve leaflet to allow it to splay apart during transcatheter heart valve implantation, thus maintaining coronary perfusion. Patient selection is based on key anatomical and imaging-derived parameters. Catheter electrosurgery involves using electrified wires to permit puncture and laceration of the leaflet. The steps undertaken to achieve a successful BASILICA procedure include access, traversal, puncture, laceration and completion, which are described in this review. Challenges faced by the BASILICA operator and practical solutions are also discussed.
- Aortic Valve (TAVR/TAVI)· Heart failure reviewsA sex-specific perspective on coronary microvascular dysfunction in HFpEF: from vascular to myocardial disease.
- Aortic Valve (TAVR/TAVI)· Herzschrittmachertherapie & ElektrophysiologieImaging phenotypes and substrates in ventricular tachycardia.
- Aortic Valve (TAVR/TAVI)· Future cardiologyOptimizing TAVI strategy: balancing predilatation benefits and direct implantation efficiency.
- Mitral Valve (Repair & Replacement)· Structural heart : the journal of the Heart TeamPreprocedural New York Heart Association Class IV Independently Predicts Mortality After Effective Edge-To-Edge Repair for Primary Mitral Regurgitation.
- Tricuspid Valve (Repair & Replacement)· JACC. Case reportsCryoextraction for Airway Bleeding After Valve-in-Valve Procedure.
- Surgical vs Transcatheter· General thoracic and cardiovascular surgeryA critical appraisal of "A novel survival prediction model after isolated surgical aortic valve replacement in the transcatheter aortic valve replacement era".