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Can We Six It? Double BASILICA Transcatheter Aortic Valve Replacement in Quadricuspid Aortic Valve.

ABSTRACT: Coronary artery obstruction is an uncommon yet devastating complication of transcatheter aortic valve replacement (TAVR) and may necessitate leaflet modification. A 38-year-old man presented to our center with quadricuspid aortic valve with severe aortic regurgitation. Double leaflet modification was performed with the Bioprosthetic or native Aortic Scallop Intentional Laceration to prevent Iatrogenic Coronary Artery obstruction (BASILICA) technique prior to TAVR, creating 6 leaflets from 4. The patient tolerated the procedure well with symptomatic improvement. Follow-up transthoracic echocardiogram showed normal bioprosthetic aortic valve function. This case demonstrates feasibility of this procedure with comprehensive preprocedural analysis and intraprocedural imaging guidance.

SUBMITTER: Shekiladze N

PROVIDER: S-EPMC11308060 | biostudies-literature | 2024 May

REPOSITORIES: biostudies-literature

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Can We Six It? Double BASILICA Transcatheter Aortic Valve Replacement in Quadricuspid Aortic Valve.

Shekiladze Nikoloz N Murphy Andrew A Babaliaros Vasilis V Ueyama Hiroki H Greenbaum Adam A Gleason Patrick P Xie Joe J

Journal of the Society for Cardiovascular Angiography & Interventions 20240229 5

Coronary artery obstruction is an uncommon yet devastating complication of transcatheter aortic valve replacement (TAVR) and may necessitate leaflet modification. A 38-year-old man presented to our center with quadricuspid aortic valve with severe aortic regurgitation. Double leaflet modification was performed with the Bioprosthetic or native Aortic Scallop Intentional Laceration to prevent Iatrogenic Coronary Artery obstruction (BASILICA) technique prior to TAVR, creating 6 leaflets from 4. The ...[more]

PMID: 39132463

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Unequal quadricuspid aortic valve stenosis treated with transcatheter aortic valve replacement.

Project description: Not available

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Transcatheter aortic valve replacement in patients with quadricuspid aortic valve in a single center.

Project description:BackgroundQuadricuspid aortic valve (QAV) is a rare congenital malformation that can present with aortic regurgitation or aortic stenosis (AS)), requiring surgical treatment. Transcatheter aortic valve replacement (TAVR) is an alternative treatment for older patients and its prognosis for QAV therapy remains challenging. We sought to examine our early experience with TAVR in patients with QAV.Materials and methodsProspectively collected data were retrospectively reviewed in patients with QAV undergoing TAVR in our institution.ResultsFive patients with QAV and AR or AS were treated with TAVR between January 2016 and January 2022. The mean age was 73.8 years (range 69-82 years), and the median Society of Thoracic Surgeons score was 7.51% (range 2.668-18.138%). Two patients had type B and three had either type A, D, or F according to the Hurwitz and Roberts classification for QAV. Four patients with pure aortic regurgitation underwent transapical TAVR using the J-Valve system, and the patient with severe AS underwent transfemoral TAVR using the Venus-A system. Procedural success was achieved in all five patients. Trivial paravalvular leak was only detected in one case after the procedure, and one patient received a permanent pacemaker due to high-degree atrioventricular block three days later. The median follow-up period was 18 (12-56) months. After discharge, no deaths occurred during the 1 year follow-up. All patients improved by ≥1 New York Heart Association functional class at 30 days; four patients were in functional class ≤II later in the follow-up period. All patients' heart failure symptoms improved considerably.ConclusionOur early experience with TAVR in QAV demonstrates these procedures to be feasible with acceptable early results. Further follow-up is necessary to determine the long-term outcomes of this modality.Clinical trial registration[ClinicalTrials.gov], identifier [NCT02917980].

| S-EPMC9554142 | biostudies-literature

Transcatheter Aortic Valve Replacement in Patients With Quadricuspid Aortic Valve: A Case Series and Systematic Review.

Project description:Background: Quadricuspid aortic valve (QAV) is a rare congenital cardiac anomaly associated with symptomatic aortic regurgitation (AR) or aortic stenosis (AS). Transcatheter aortic valve replacement (TAVR) for QAV remains uncertain. Methods: We retrospectively reviewed prospectively collected data from patients with QAV undergoing TAVR in our center and conducted a systematic literature review for further investigation. Results: Five patients with QAV were treated with TAVR between April 2016 and December 2023. The median age was 67 years (range: 59-86), and the median Society of Thoracic Surgeons score (STS-score) was 3.750% (range: 0.916%-11.823%). Procedural success was achieved in all cases. The median follow-up period was 3 years (from 30 days to 7 years). Four of the patients exhibited no serious complications, while one experienced delayed coronary obstruction. Our systematic review included 31 cases from 21 publications and our center. The median age of patients was 79 years (range: 57-90), including 18 males. The median STS score was 7.835%. Severe AS was present in 64.5% of the patients and severe AR in 41.9%. The most common QAV subtype was type B (48.4%). Technical success was achieved in 100% of the cases, with two cases reporting coronary obstruction and one required a permanent pacemaker implantation. During a median follow-up period of 1 year (from 30 days to 7 years), one case experienced serious complications of delayed coronary obstruction. Conclusion: The TAVR may be an alternative treatment for patients with QAV, preliminarily demonstrating feasible early and long-term results from current experience. However, extra precautions regarding coronary artery obstruction complications are necessary due to the rarity and anatomical complexity of QAV.

| S-EPMC11824809 | biostudies-literature

Preventing Coronary Obstruction During Transcatheter Aortic Valve Replacement: From Computed Tomography to BASILICA.

Project description:Coronary artery obstruction is an uncommon but devastating complication of transcatheter aortic valve replacement (TAVR). Computed tomography appears to be a sensitive but nonspecific predictor of coronary artery obstruction. Transcatheter approaches to prevent and treat coronary artery obstruction, such as "snorkel" stenting, are unsatisfactory because of serious early and late ischemic complications. Bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction during TAVR (BASILICA) is an early-stage transcatheter procedure to prevent coronary artery obstruction. It works by splitting the native or bioprosthetic leaflets so that they splay after TAVR and preserve coronary artery inflow. Because of the paucity of suitable alternatives, there is interest in the BASILICA technique despite its infancy. This tutorial review summarizes current thinking about how to predict and prevent coronary artery obstruction using BASILICA. First, the authors depict the main pathophysiological mechanisms of TAVR-associated coronary artery obstruction, along with the factors thought to contribute to coronary obstruction. Next, the authors provide a step-by-step guide to analyzing pre-procedural computed tomographic findings to assess obstruction risk and, if desirable, to plan BASILICA. Next, the authors describe the mechanisms underlying transcatheter electrosurgery. Finally, they provide step-by-step guidance on how to perform the procedure, along with a required equipment list.

| S-EPMC6724191 | biostudies-literature

Transcatheter aortic valve replacement planning with cardiac computed tomography in quadricuspid aortic valve stenosis: a case series.

Project description:BackgroundThe presence of severe aortic stenosis in quadricuspid aortic valve (QAV) is an extremely rare combination, and it is unknown whether transcatheter aortic valve replacement (TAVR) is a safe option due to the low incidence.Case summaryWe present two patients diagnosed with severe aortic stenosis with QAV morphology type 1 (Nakamura classification). All patients presented to our hospital for evaluation because of worsening functional class, dyspnoea, or syncope. During tomographic planning, the aortic annulus was measured at the level of the deepest sinus for the selection of the number of devices. Due to the presence of four cusps, the smallest cusp was excluded, and three sinuses were virtualized for placement of the pigtail catheter during the procedure. Without complications, a 23 mm Edwards SAPIEN 3 was deployed through the femoral artery in both patients. Control aortography showed no valve leakage or regurgitation.DiscussionIn patients with QAV and aortic stenosis undergoing TAVR, similar to the tricuspid valve, tomographic planning can be used to ensure the success of the procedure. However, unlike the tricuspid valve, where the selection of the device number is based on the measurements of the aortic annulus at the level of the non-coronary sinus, in these QAV cases, we perform the measurements at the level of the deepest aortic sinus (right coronary sinus).

| S-EPMC10894008 | biostudies-literature

Transcatheter aortic valve replacement in quadricuspid aortic valve: the crucial role of three-dimensional simulation in risk assessment.

Project description: Not available

| S-EPMC11195803 | biostudies-literature

Preventing Coronary Obstruction During Transcatheter Aortic Valve Replacement: Results From the Multicenter International BASILICA Registry.

Project description:ObjectivesThis study sought to determine the safety of the BASILICA (bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction) procedure.BackgroundTranscatheter aortic valve replacement causes coronary artery obstruction in 0.7% of cases, with 40% to 50% mortality. BASILICA is a procedure to prevent coronary obstruction. Safety and feasibility in a large patient cohort is lacking.MethodsThe international BASILICA registry was a retrospective, multicenter, real-world registry of patients at risk of coronary artery obstruction undergoing BASILICA and transcatheter aortic valve replacement. Valve Academic Research Consortium-2 definitions were used to adjudicate events.ResultsBetween June 2017 and December 2020, 214 patients were included from 25 centers in North America and Europe; 72.8% had bioprosthetic aortic valves and 78.5% underwent solo BASILICA. Leaflet traversal was successful in 94.9% and leaflet laceration in 94.4%. Partial or complete coronary artery obstruction was seen in 4.7%. Procedure success, defined as successful BASILICA traversal and laceration without mortality, coronary obstruction, or emergency intervention, was achieved in 86.9%. Thirty-day mortality was 2.8% and stroke was 2.8%, with 0.5% disabling stroke. Thirty-day death and disabling stroke were seen in 3.4%. Valve Academic Research Consortium-2 composite safety was achieved in 82.8%. One-year survival was 83.9%. Outcomes were similar between solo and doppio BASILICA, between native and bioprosthetic valves, and with the use of cerebral embolic protection.ConclusionsBASILICA is safe, with low reported rates of stroke and death. BASILICA is feasible in the real-world setting, with a high procedure success rate and low rates of coronary artery obstruction.

| S-EPMC8142224 | biostudies-literature

Midterm Degeneration of Transcatheter Heart Valve Device following Valve-in-Valve Transcatheter Aortic Valve Replacement Requiring Repeat Transcatheter Aortic Valve Replacement.

Project description: Not available

| S-EPMC7451866 | biostudies-literature

Mitral and aortic regurgitation following transcatheter aortic valve replacement.

Project description:To analyse the impact of postprocedural mitral regurgitation (MR), in an interaction with aortic regurgitation (AR), on mortality following transcatheter aortic valve implantation (TAVI).To assess the interaction between MR and AR, we compared the survival rate of patients (i) without both significant MR and AR versus (ii) those with either significant MR or significant AR versus (iii) with significant MR and AR, all postprocedure. 381 participants of the Polish Transcatheter Aortic Valve Implantation Registry (166 males (43.6%) and 215 females (56.4%), age 78.8±7.4 years) were analysed. Follow-up was 94.1±96.5 days.In-hospital and midterm mortality were 6.6% and 10.2%, respectively. Significant MR and AR were present in 16% and 8.1% patients, including 3.1% patients with both significant MR and AR. Patients with significant versus insignificant AR differed with respect to mortality (log rank p=0.009). This difference was not apparent in a subgroup of patients without significant MR (log rank p=0.80). In a subgroup of patients without significant AR, there were no significant differences in mortality between individuals with versus without significant MR (log rank p=0.44). Significant MR and AR had a significant impact on mortality only when associated with each other (log rank p<0.0001). At multivariate Cox regression modelling concomitant significant MR and AR were independently associated with mortality (OR 3.2, 95% CI 1.54 to 5.71, p=0.002).Significant MR or AR postprocedure, when isolated, had no impact on survival. Combined MR and AR had a significant impact on a patient's prognosis.

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Transcatheter Aortic Valve Replacement for Bicuspid Aortic Insufficiency After Valve-Sparing Aortic Root Replacement.

Project description:Bicuspid aortic insufficiency (BAI) patients with root aneurysm often require aortic valve and root replacement in a composite procedure. The valve-sparing root replacement (VSARR) procedure is aimed at preserving the native valve when possible. This case highlights a successful transcatheter aortic valve replacement procedure in a BAI patient previously treated with VSARR. (Level of Difficulty: Intermediate.).

| S-EPMC8642721 | biostudies-literature

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