BASILICA: a Complex Strategy, Yet Safe

Coronary artery obstruction (CAO) after TAVR is rare, but it entails extremely high mortality (50% or more), especially after valve-in-valve (V-in-V) or when the coronary ostia are is too close to the valve annulus.

Cortar las valvas, una medida extrema para evitar la oclusión coronaria post TAVI

This is why the BASILICA technique was developed (Bioprosthetic or Native Aortic Scallop Intentional Laceration to Prevent Iatrogenic Coronary Artery Obstruction). However, at present there is little information on outcomes and target patients. 

The study looked at the multicenter EURO-BASILICA registry (conducted between 2017 and 2021) including 76 patients and 85 valves banned from surgery and at the risk of CAO.

Primary end point was feasibility, efficacy and safety of the BASILICA technique.

Mean age was 79, 60.5% were women, 86% presented hypertension, 19.7% diabetes, 9.2% MI, 29% CABG, 11.8% peripheral vascular disease, 10.5% stroke, 14.5% definite pacemaker, and 4% kidney failure or dialysis. 

Surgical bioprosthesis degeneration time was 9 (7-11) years.

Mortality STS was 4.8%, EuroScore II 4.8 and Losgistic EuroSCORE was 28.

Read also: Evolute Low Risk at 3 Years: Promising Outcomes.

The BASILICA technique was done in surgical bioprosthesis (92.1%), native valves (5.3%) and transcatheter valves (2.6%).

Procedures were done under general anesthesia and trans-esophageal eco-Doppler.

Single valve BASILICA resulted 88.2% and doulble, 11.8%. Procedural time was 53 (38-77) minutes.

The Evolute was used in 84.2% of cases and the SAPIEN 3 in the rest.

Read also: PICCOLETO-II: Drug-Coated Balloons in Small Vessels.

El éxito técnico se alcanzó en el 97.7% de las valvas y el éxito del procedimiento en el 88.2%. Dos pacientes presentaron OC y 5 obstrucción parcial; a estos se les realizó angioplastia (ATC) con stent.

A 30 días la sobrevida fue de 98.7% y la mayoría estaban en CF I-II. Además, un paciente presentó stroke mayor, otro stroke menor y se produjo una muerte por sangrado mayor. La necesidad de marcapasos fue del 4% y ninguno presentó leak moderado o severo. La rehospitalización fue del 8%.

La sobrevida al año fue del 84.2% y el 90.5% estaba en clase funcional I-II. Además, un paciente presentó stroke y ninguno oclusión coronaria. Ningún paciente exhibió leak moderado o severo.

Read also: Retrograde Tibial Access for Endovascular Treatment of Femoropopliteal Occlusions: Is it a Safe Strategy?

Los predictores de OC fueron la edad, las válvulas quirúrgicas stentless y cuando la válvula percutánea presentaba un implante alto.

Conclusión

El Registro EURO-BASILICA es el primer registro en evaluar la técnica BASILICA en EUROPA. Esta técnica parece ser factible y efectiva en prevenir la oclusión coronaria en el TAVI. En efecto, a un año de seguimiento la evolución fue favorable. El riesgo de oclusión coronaria requiere más estudios.

Dr. Carlos Fava - Consejo Editorial SOLACI

Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.

Original Title: Procedural and one-year outcomes of the BASILICA technique in Europe: the multicentre BASILICA Registry.

Reference: Mohamed Abdel-Wahab, et al. EuroIntervention 2023;19-online publish-ahead-of-print April 2023. 


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