June 23, 2020
MountainView Hospital is now offering BASILICA, also known as Bioprosthetic Aortic Scallop Intentional Laceration, during transcatheter aortic valve replacement (TAVR) for high-risk patients in which traditional valve replacement procedures may be too risky or not an option.
The new BASILICA procedure works to prevent Iatrogenic Coronary Artery obstruction, and increases options for high-risk patients in which traditional valve replacement procedures may be too risky or not an option.
TAVR is a minimally-invasive procedure that treats about two thirds of patients with aortic stenosis. About 1.5 million people in the United States suffer from aortic stenosis, a disease that develops over time and causes the aortic valve to narrow or obstruct.
Aortic valve stenosis is the narrowing of the valve that controls blood leaving the heart to the rest of the body. This is a crucial matter as the narrowing causes a decrease of blood to vital organs, leading to shortness of breath, chest pain, blackouts and heart failure.
A TAVR is a procedure that involves threading a long, thin, flexible tube or catheter through the femoral artery in the leg to the heart. From the catheter, a balloon is used to open a new valve inside the aortic valve.
For most adults or frail patients, TAVR is an effective and less invasive option to open heart surgery. Unfortunately, in some patients whose hearts have uncommon structures, such as unusually large valve leaflets that open and close the aortic valve or small aortic roots, complications like coronary artery obstruction may occur during TAVR. During a coronary artery obstruction, the leaflets from the native valve can block the artery opening when the new valve is implanted, preventing the flow of blood to the coronary arteries.
BASILICA, is a new technique developed to prevent such complications during TAVR, increases treatment options for high-risk patients who need heart valve procedures. BASILICA involves a cardiologist utilizing an electrified wire the size of a sewing thread through a catheter to split the original leaflet in two so that it cannot block the coronary artery once it has been pushed aside by the new transcatheter heart valve.
“The BASILICA procedure is exciting news for the medical community,” says Dr. Jeffrey Levisman, Chief of Cardiology at MountainView Hospital and Interventional Cardiologist at MountainView's Las Vegas Heart Associates. “There was no good way to prevent TAVR-induced coronary obstruction before. BASILICA allows more patients, who may not have been candidates before, to consider a transcatheter valve replacement.”
BASILICA presents some advantages such as its efficiency and simplicity, it does not leave behind a stent implant (such as “snorkel” stent), it is attractive for patients who are at high risk for surgical aortic valve replacement, and can be performed using moderate sedation and next day discharge.
MountainView hospital is a leader in TAVR, selected as one of seven sites nationally to serve as a model for the minimalist approach. This approach involves avoiding surgical incision at the site of entry of the catheter as well as not utilizing general anesthesia, which can delay recovery. This technique has been shown to improve outcomes and decrease all complications.