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

MedStar author(s):
Citation: Jacc: Cardiovascular Interventions. 12(13):1197-1216, 2019 07 08.PMID: 31272666Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal Article | ReviewSubject headings: *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 PatencyYear: 2019Local holdings: Available online through MWHC library: 2008 - presentISSN:
  • 1936-8798
Name of journal: JACC. Cardiovascular interventionsAbstract: 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.All authors: Babaliaros VC, Dvir D, Greenbaum AB, Kamioka N, Khan JM, Lederman RJ, Rogers TOriginally published: Jacc: Cardiovascular Interventions. 12(13):1197-1216, 2019 Jul 08.Fiscal year: FY2020Digital Object Identifier: Date added to catalog: 2019-07-24
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 31272666 Available 31272666

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.

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