Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w
EURO-BASILICA: Outcomes of a multicentre European experience with transcatheter electrosurgical leaflet splitting to prevent TAVI-induced coronary obstruction
I. Richter1, M. Taramasso2, A. Unbehaun3, T. K. Rudolph4, F. Ribichini5, R. Binder6, J. Schofer7, N. Mangner8, J.-H. Dambrink9, B. Trejo-Velasco1, H. Thiele1, M. Kitamura1, J. Lanz10, M. Abdel-Wahab1
1Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig - Universität Leipzig, Leipzig; 2Department of Cardiac Surgery, HerzZentrum Hirslanden, Zürich; 3Klinik für Herz-, Thorax- und Gefäßchirurgie, Deutsches Herzzentrum Berlin, Berlin; 4Allgemeine und Interventionelle Kardiologie/Angiologie, Herz- und Diabeteszentrum NRW, Bad Oeynhausen; 5Department of Medicine, University of Verona, Verona, IT; 6Department of Cardiology and Intensive Care, University Teaching Hospital Klinikum Wels-Grieskrichen, Wels, AT; 7Prof. Mathey, Prof. Schofer GmbH, Medizinisches Versorgungszentrum, Hamburg; 8Klinik für Innere Medizin, Kardiologie und Intensivmedizin, Herzzentrum Dresden GmbH an der TU Dresden, Dresden; 9Department of Cardiology, Isala Klinieken De Weezenlanden Hospital, Zwolle, NL; 10Department of Cardiology, Bern University Hospital, Bern, CH;

Objectives: To evaluate procedural and one-year outcomes of bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction (BASILICA) in patients at high-risk for coronary artery obstruction (CAO) undergoing transcatheter aortic valve implantation (TAVI) in a multicentre European registry (EURO-BASILICA).

Background: Outcomes of the BASILICA technique in multicentre studies remain scarce.

Methods: Seventy-six patients undergoing BASILICA and TAVI at ten European centres were included. Eighty-five leaflets were identified as target for BASILICA due to high risk for CAO following leaflet deflection. The updated Valve Academic Research Consortium-3 (VARC-3) definitions were used to determine prespecified endpoints of technical and procedural success and adverse events up to one year.

Results: Treated aortic valves included native (5.3%), surgical bioprosthetic (92.1%) and transcatheter valves (2.6%). Double-BASILICA (for both left- and right-coronary cusps) was performed in 11.8%. Technical success of BASILICA was achieved in 97.7% and resulted in freedom from any BASILICA-related CAO in 90.6% of leaflets with a low rate of complete CAO (2.4%). CAO despite BASILICA occurred significantly more often in older and stentless bioprosthetic valves. Procedural success was 88.2%, and freedom from VARC-3 defined early safety endpoints was 79.0%. One-year survival was 90.8%; 67.1% of patients were in New York Heart Association (NYHA) functional class I/II.

Conclusion: EURO-BASILICA is the first multicentre study evaluating the BASILICA technique in Europe. The technique appeared feasible and effective in preventing TAVI-induced CAO, and one-year clinical outcomes were favorable. The residual risk for CAO requires further studies.
https://dgk.org/kongress_programme/jt2023/aV7.html