Bioprosthetic aortic valve leaflet disruption with high energy electrocautery to prevent coronary artery obstruction during valve-in-valve transcatheter aortic valve replacement

Catheter Cardiovasc Interv. 2019 Jan 1;93(1):164-168. doi: 10.1002/ccd.27721. Epub 2018 Oct 8.

Abstract

Transcatheter aortic valve replacement (TAVR) is well-established for the treatment of bioprosthetic aortic valve stenosis (AS) in high surgical risk patients. Coronary artery obstruction from displacement of the bioprosthetic valve leaflets during valve-in-valve (VIV) TAVR is a rare, but potentially fatal, complication. Recently, the bioprosthetic aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction (BASILICA) procedure was developed as a method for disrupting bioprosthetic leaflets in patients undergoing VIV TAVR at high risk for coronary obstruction. This case describes a successful VIV TAVR utilizing a simplified concept of the BASILICA technique in a patient where the full procedure could not be completed.

Keywords: aortic stenosis; coronary artery obstruction; transcatheter aortic valve replacement; valve-in-valve.

Publication types

  • Case Reports
  • Video-Audio Media

MeSH terms

  • Aged
  • Aortic Valve Insufficiency / diagnostic imaging
  • Aortic Valve Insufficiency / etiology
  • Aortic Valve Insufficiency / physiopathology
  • Aortic Valve Insufficiency / surgery*
  • Aortic Valve Stenosis / diagnostic imaging
  • Aortic Valve Stenosis / etiology
  • Aortic Valve Stenosis / physiopathology
  • Aortic Valve Stenosis / surgery*
  • Bioprosthesis*
  • Coronary Stenosis / etiology
  • Coronary Stenosis / prevention & control*
  • Electrocoagulation*
  • Heart Valve Prosthesis Implantation / adverse effects
  • Heart Valve Prosthesis Implantation / instrumentation*
  • Heart Valve Prosthesis*
  • Humans
  • Male
  • Prosthesis Design
  • Transcatheter Aortic Valve Replacement / adverse effects
  • Treatment Outcome