CoreValve bioprosthesis dysfunction treated with a Sapien 3 valve‐in‐valve transcatheter aortic valve replacement and BASILICA technique

Abstract

Structural deterioration of transcatheter heart valve (THV) has been previously described. With the expansion of transcatheter aortic valve replacement (TAVR) indications toward treating lower risk patients with longer life expectancy, there will be increased necessity of managing the patients with THV dysfunction including those at risk for coronary obstruction or sinus sequestration. Coronary access also remains a challenge in such cases with THV dysfunction undergoing valve‐in‐transcatheter heart valve (ViTHV) TAVR. A unique and first reported case of THV deterioration treated with Sapien 3 ViTHV‐TAVR inside a 31 mm CoreValve bioprosthesis along with left coronary leaflet laceration using the BASILICA technique has been presented.

The Use of BASILICA Technique to Prevent Coronary Obstruction in a TAVI-TAVI Procedure

“…There are several unique concerns when a TAVI-in-TAVI BASILICA is planned, such as to ensure that the guidewire does not traverse through the stent frame and stays within the previous THV and to avoid interaction of the wire loop with the lower skirt of the THV [ 38 ]. Another concern is the possibility that the outer TAVI leaflets could get pinned against their frame by the inner TAVI device and, thereby, failing to splay and allow coronary perfusion [ 27 ].…”

“…In that case, the patient was at risk for sinus sequestration and impeding coronary access; thus, a left cusp BASILICA followed by a SAPIEN 3 implantation within a degenerated 31 mm CoreValve was performed. Regarding equipment, the authors described having used standard BASILICA equipment [ 38 ].…”