Preventing Coronary Obstruction During Transcatheter Aortic Valve Replacement: From Computed Tomography to BASILICA. [Review]
Preventing Coronary Obstruction During Transcatheter Aortic Valve Replacement: From Computed Tomography to BASILICA. [Review]
- 2019
Available online through MWHC library: 2008 - present
Copyright Published by Elsevier Inc. 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.
English
1936-8798
10.1016/j.jcin.2019.04.052 [doi] S1936-8798(19)31109-4 [pii]
*Aortic Valve/su [Surgery]
*Coronary Stenosis/pc [Prevention & Control]
*Electrosurgery
*Iatrogenic Disease/pc [Prevention & Control]
*Tomography, X-Ray Computed
*Transcatheter Aortic Valve Replacement
Aortic Valve/dg [Diagnostic Imaging]
Aortic Valve/pp [Physiopathology]
Bioprosthesis
Coronary Circulation
Coronary Stenosis/dg [Diagnostic Imaging]
Coronary Stenosis/et [Etiology]
Coronary Stenosis/pp [Physiopathology]
Electrosurgery/ae [Adverse Effects]
Electrosurgery/is [Instrumentation]
Heart Valve Prosthesis
Humans
Predictive Value of Tests
Prosthesis Design
Risk Assessment
Risk Factors
Transcatheter Aortic Valve Replacement/ae [Adverse Effects]
Transcatheter Aortic Valve Replacement/is [Instrumentation]
Treatment Outcome
Vascular Patency
MedStar Heart & Vascular Institute
Journal Article
Review
Available online through MWHC library: 2008 - present
Copyright Published by Elsevier Inc. 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.
English
1936-8798
10.1016/j.jcin.2019.04.052 [doi] S1936-8798(19)31109-4 [pii]
*Aortic Valve/su [Surgery]
*Coronary Stenosis/pc [Prevention & Control]
*Electrosurgery
*Iatrogenic Disease/pc [Prevention & Control]
*Tomography, X-Ray Computed
*Transcatheter Aortic Valve Replacement
Aortic Valve/dg [Diagnostic Imaging]
Aortic Valve/pp [Physiopathology]
Bioprosthesis
Coronary Circulation
Coronary Stenosis/dg [Diagnostic Imaging]
Coronary Stenosis/et [Etiology]
Coronary Stenosis/pp [Physiopathology]
Electrosurgery/ae [Adverse Effects]
Electrosurgery/is [Instrumentation]
Heart Valve Prosthesis
Humans
Predictive Value of Tests
Prosthesis Design
Risk Assessment
Risk Factors
Transcatheter Aortic Valve Replacement/ae [Adverse Effects]
Transcatheter Aortic Valve Replacement/is [Instrumentation]
Treatment Outcome
Vascular Patency
MedStar Heart & Vascular Institute
Journal Article
Review