Echocardiographic Guidance of Intentional Leaflet Laceration prior to Transcatheter Aortic Valve Replacement: A Structured Approach to the Bioprosthetic or Native Aortic Scallop Intentional Laceration to Prevent Iatrogenic Coronary Artery Obstruction Procedure

J Am Soc Echocardiogr. 2021 Jun;34(6):676-689. doi: 10.1016/j.echo.2021.01.015. Epub 2021 Mar 3.

Abstract

Bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction (BASILICA) is a recently developed technique to reduce the risk of ostial coronary obstruction during transcatheter aortic valve replacement. Intraprocedural fluoroscopy and transesophageal echocardiography imaging are used complimentarily to guide the procedure. So far, no structured echocardiographic imaging protocol has been described for this intervention. Based on an experience of more than 50 BASILICA procedures at two different institutions, we present a step-by-step approach for transesophageal echocardiography guidance during BASILICA and highlight anatomical and procedural characteristics from an echocardiographic perspective.

Keywords: BASILICA; Echocardiography; Guidance; Multiplane imaging; TEE.

Publication types

  • Review

MeSH terms

  • Animals
  • Aortic Valve / diagnostic imaging
  • Aortic Valve / surgery
  • Aortic Valve Stenosis* / surgery
  • Coronary Vessels
  • Echocardiography, Transesophageal
  • Fluoroscopy
  • Heart Valve Prosthesis* / adverse effects
  • Humans
  • Iatrogenic Disease / prevention & control
  • Lacerations*
  • Pectinidae*
  • Transcatheter Aortic Valve Replacement* / adverse effects
  • Treatment Outcome