- New Bioprosthetic Aortic Scallop Intentional
Laceration to prevent Iatrogenic Coronary Artery obstruction (BASILICA)
technique reduces mortality in high risk patients undergoing heart valve
- According to the American Heart
Association, 5 million people in the United States are diagnosed with
heart valve disease annually, and more than 20,000 die.
A new technique developed recently
significantly reduces risk of coronary artery obstruction during transcatheter aortic valve replacement
a rare but often lethal complication in some patients, according to
a research team
at the National Institutes of Health.
findings of the study appeared in the Journal of the American
College of Cardiology: Cardiovascular Interventions.
Aim of the BASILICA Technique
BASILICA procedure was developed by Jaffar M. Khan, M.D., at the National,
Heart, Lung, and Blood Institute (NHLBI), part of NIH, to make the TAVR
procedure safer in some patients who experience coronary vessel obstruction
during this procedure, many of whom die.
The BASILICA Procedure
this procedure, the interventional cardiologist introduces an electrified wire, the size of a sewing thread through the catheter and uses
it to cut the original leaflet into two,
so that it can no
longer block the coronary artery when the new transcatheter aortic valve is
positioned in the heart.
Findings of the Current Study
- In the current study, the scientists
found the BASILICA procedure to be
successful in seven critically ill patients who qualified for the procedure
on compassionate groundsuntil
then untested in humans, and no other treatment options available at that
this new procedure provides a solution and gives hope to many patients who are
at risk from the conventional TAVR procedure
‘The BASILICA procedure can potentially reduce the number of deaths due to transcatheter aortic valve replacement (TAVR).’
patients had a successful TAVR with no coronary obstruction, stroke or any
major complication," said Dr Robert J Lederman, M.D., the senior
investigator in NHLBI's Division of Intramural Research who led the study with
Khan. "They were doing well as they reached the 30-day-mark after the
What is TAVR Procedure?
- TAVR, a procedure used to treat
aortic valve stenosis
involves maneuvering a long, thin, flexible tube through an artery in the
leg up into the heart.
- Aortic valve stenosis refers to
severe narrowing of the valve that regulates blood leaving the heart to
the rest of the body. Thus this narrowing reduces blood flow to vital
organs, leading to chest pain, fatigue, breathlessness, blackouts, and
- For elderly or frail patients with
aortic valve stenosis, TAVR provides a highly effective and less invasive
alternative to open heart surgery.
Why Is TAVR Considered
Unsafe In Some Patients?
TAVR, the cardiologist guides a catheter inside the heart and uses a balloon to
replace a new valve inside the damaged aortic valve.
in some patients having abnormal or
unusual physical heart structure, such as very large valve leaflets or small
(site of origin of the coronary vessel), the large leaflets
block blood flow to the coronary arteries (cutting off blood supply to heart)
as the new valve's scaffolding releases open.
Dr Lederman, "These patients are either not eligible for conventional
TAVR, or they are at high risk for it.
is no good treatment or prevention strategy for TAVR-induced coronary
obstruction. The previous technique of using a stent to open the coronary
artery appears to have poor long-term outcomes."
an early multiple center feasibility study backed by the National Heart, Lung
and Blood Institute (NHLBI), which began enrolling patients in January the
efficacy of the BASILICA procedure will be reassessed.
conclusion, it is hoped the BASILICA technique will eventually help reduce the
number of deaths from heart valve disease or related procedures.
- New technique makes heart valve replacement safer for some high-risk patients - (https://www.nih.gov/news-events/news-releases/new-technique-makes-heart-valve-replacement-safer-some-high-risk-patients)
- Jaffar M. Khan, Danny Dvir, Adam B. Greenbaum, Vasilis C. Babaliaros, Toby Rogers, Gabriel Aldea, Mark Reisman, G. Burkhard Mackensen, Marvin H.K. Eng, Gaetano Paone, Dee Dee Wang, Robert A. Guyton, Chandan M. Devireddy, William H. Schenke, Robert J. Lederman. "Transcatheter Laceration of Aortic Leaflets to Prevent Coronary Obstruction During Transcatheter Aortic Valve Replacement.", JACC: Cardiovascular Interventions, (2018); 11 (7): 677 DOI: 10.1016/j.jcin.2018.01.247