BASILICIA before TAVR is safe and effective, new data confirms
Performing the BASILICA procedure immediately before transcatheter aortic valve replacement (TAVR) is a safe and effective way to limit coronary artery obstruction, according to new research published in JACC: Cardiovascular Interventions.
During BASILICA, catheters and guidewires are used to intentionally lacerate the aortic leaflet in a way that preserves coronary perfusion. As it continues to gain momentum, the procedure could help certain high-risk patients undergo TAVR who may have not been recommended for it otherwise.
The study’s authors tracked data from 214 patients who underwent BASILICIA immediately before TAVR from June 2017 to December 2020. Patients were treated at one of 25 centers throughout North American and Europe. The mean patient age was 74.9 years old.
Overall, the procedure had a success rate of 86.9%. The mortality rate and stroke rate after 30 days were both 2.8%. Disabling stroke was reported in just 0.5% of patients.
Pre-TAVR BASILICA occurred in native aortic valves for 27.2% of patients and in failed bioprosthetic valves for the other 72.8%. Outcomes were similar between those two patient groups, the authors observed.
Even after BASILICIA, partial or complete coronary artery obstruction was still seen in 4.7% of patients. One of those patients died, and four patients had evidence of periprocedural myocardial infarction.
“This compares favorably to the 40% to 50% mortality rate reported in registries when BASILICA is not performed,” wrote lead author Jaffar M. Khan, BM BCh, PhD, of the National Heart, Lung and Blood Institute, and colleagues. “This is likely because the majority of the coronary artery obstruction cases reported in this registry were not flow-limiting. Furthermore, many were orthotopically stented through the struts of the transcatheter heart valve into the coronary ostium, made possible by BASILICA, rather than ‘snorkeled’ alongside the transcatheter heart valve.
Though certain risks do remain, Khan et al. said BASILICIA does seem to be a “favorable solution” for treating patients at an especially high risk for coronary obstruction. Also, the group noted, these “reassuring” findings “should facilitate wider dissemination of the BASILICIA procedure at high-volume centers.”
Click here for the full analysis.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.