Extended Basilica Procedure: An Unusual Case of TAVR—Valve in Valve

<p> A ninety-one-year-old man presented with shortness of breath and exercise intolerance because of a bioprosthetic aortic valve degeneration with severe regurgitation and moderate stenosis. He also had a history of a surgical implantation of an aortic bioprosthetic valve (Sorin Mitroflow 21mm in 2012) because of a severe fibro-degenerative aortic valve stenosis.</p><p></p> <p> </p> <p>The patient was refused conventional valve-in-vale (ViV) procedure because of very low implantation of both coronary ostium with a very high risk of coronary artery occlusion and also refused for a conventional redo cardiac surgery (STS score of 7.8%). A Basilica procedure was not an option because of the unfavorable anatomy and the lack of experience in the patient’s country. The patient was advised to continue medical treatment despite his symptoms and the poor quality of life.</p><p><br></p><p>References</p><p> </p><p>1- Khan JM, Dvir D, Greenbaum Ab, et al. Trans- catheter laceration of aortic leaflets to prevent coronary obstruction during transcatheter aortic valve replacement: Concept to first-in-human. J Am Coll Cardiol Intv 2018;11:677–89.</p><p>2- Babaliaros VC, Greenbaum AB, khan JM, et al. Intentional percutaneous laceration of the anterior mitral leaflet to prevent outflow obstruction during transcatheter mitral valve replacement: First- in-human experience. J Am Coll Cardiol Intv 2017;10:798–809.</p><p>3- Lederman et al . Preventing coronary obstruction during transcatheter aortic valve implantation. J Am Coll Cardiol : cardiovascular july 8, 2019:1197–216 interventions vol. 12, no. 13, 2019</p><p>4- John C Lisko, Vasilis C Babaliaros , Robert J Lederman et al. Pachyderm-Shape Guiding Catheters to Simplify BASILICA Leaflet Traversal Cardiovasc Revasc Med. 2019 sep;20(9):782-785.</p><p> 5- Khan JM et al. The BASILICA Trial: Prospective Multicenter Investigation of Intentional Leaflet Laceration to Prevent TAVR Coronary Obstruction. J Am Coll Cardiol Intv. 2019 jul 8;12(13):1240-1252<br></p>