Abstract
Transcatheter aortic valve implantation (TAVI) to manage structural bioprosthetic valve deterioration has been successful in mitigating the risk of a redo cardiac surgery. However, TAVI-in-TAVI is a complex intervention, potentially associated with feared complications such as coronary artery obstruction. Coronary obstruction risk is especially high when the previously implanted prosthesis had supra-annular leaflets and/or the distance between the prosthesis and the coronary ostia is short. The BASILICA technique (bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction) was developed to prevent coronary obstruction during native or valve-in-valve interventions but has now also been considered for TAVI-in-TAVI interventions. Despite its utility, the technique requires a not so widely available toolbox. Herein, we discuss the TAVI-in-TAVI BASILICA technique and how to perform it using more widely available tools, which could spread its use.
Highlights
The introduction of transcatheter aortic valve implantation (TAVI) in 2002, as an alternative to treat patients with severe aortic valve stenosis who previously had only surgery as an intervention option, represented a huge mark in the structural heart disease management revolution [1].Recently, the American and European Guidelines for the management of valvular heart disease have recommended TAVI in several clinical scenarios provided that the anatomy is favorable for performing a transfemoral approach [2,3]
According to the American College of Cardiology (ACC) and American Heart Association (AHA) Guideline, TAVI may be considered in patients above 65 years and should be the first choice in those above 80 years [2]
TAVI-in-TAVI is defined as a second transcatheter heart valve (THV) deployment within a previously implanted bioprosthesis because of suboptimal device position and/or function, during or after the procedure [8]
Summary
The introduction of transcatheter aortic valve implantation (TAVI) in 2002, as an alternative to treat patients with severe aortic valve stenosis who previously had only surgery as an intervention option, represented a huge mark in the structural heart disease management revolution [1]. To the European Society of Cardiology (ESC) and European Association for Cardio-Thoracic Surgery (EACTS) Guideline, TAVI should be chosen for those above 75 years and with high surgical risk (STS score or EuroScore ≥ 8) [3]. These changes in the last Guidelines, compared to the previous ones, were corroborated by important randomized clinical trials, whose results showed TAVI non-inferiority, or even superiority, compared to surgical aortic valve replacement (SAVR), in low-risk patients with a mean age of 73 and 74 years in the PARTNER 3 and EVOLUT Low-risk trials, respectively [4,5]. We provide an updated and comprehensive literature review focused on TAVI-in-TAVI BASILICA, and we illustrate this concept with a case report
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