Coronary obstruction is a complication from TAVR that can cause death (up to 50% mortality), even though its incidence is lower than 1%.
One of the most frequent strategies used in the prevention of this complication is chimney stenting in patients at high anatomical risk (valve in valve, narrow sinotubular junction, short coronary ostium height). The BASILICA technique has been presented to reduce chimney stenting limitations, which can be stent distortion, restenosis, thrombosis and following coronary canalization.
Primary end point was MACE estimation at one year (all cause mortality, AMI, stroke or target vessel revascularization) Secondary events were individual primary end point components, technical complications (VARC 3 criteria) and technical success defined as clinically relevant absence of obstruction.
168 patients were included, mean age 80. Chimney stenting patients received 38% of left main PCI, 17% right coronary PCI and 45% both left main and right coronary PCI. The basilica group received a single leaflet laceration in 14.4% of cases and dual laceration in 85.6%.
Read also: EuroPCR 2023 | Events after Redo TAVR in Balloon-Expandable Valves.
Technical success was observed in 98.5% in the Chimney stenting group and 96.9% in BASILICA patients (P=0.48). Also, there was freedom from bailout stenting (for partial ostial obstruction) in 98.5% of chimney stenting patients and 91.8% of BASILICA patients (p=0.052).
MACE rates resulted similar (18.7% vs 19.9%, P=0.848), while separate primary end components saw lower cardiovascular mortality among BASILICA patients (6.7% vs 1.3%; P=0.168) and lower all-cause mortality (16.2% vs 13.2%).
The author has concluded that the Chimney Stenting and BASILICA strategies were comparable when looking at periprocedural complications and at one year, with lower figures among BASILICA patients. This is the first head to head analysis of a real-world population to show the safety of this technique.
Dr. Omar Tupayachi.
Member of the Editorial Board of SOLACI.org.
Reference:Presented by Antonio Mangiere at Late Breaking Trials Sessions, EuroPCR 2023, May 16, 2023, Paris, France.
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