Long-term outcomes of BASILICA and TAVI: Results from the multicenter EURO-BASILICA registry

I. Richter (Leipzig)¹, M.-L. Tolle (Leipzig)², A. Abdelhafez (Leipzig)², M. Taramasso (Zürich)³, A. Unbehaun (Berlin)⁴, T. K. Rudolph (Bad Oeynhausen)⁵, F. L. Ribichini (Verona)⁶, R. Binder (Wels)⁷, J. Schofer (Hamburg)⁸, N. Mangner (Dresden)⁹, J.-H. Dambrink (Zwolle)¹⁰, O. Dumpies (Leipzig)², J. Lanz (Bern)¹¹, O. De Backer (Copenhagen)¹², H. Thiele (Leipzig)², M. Abdel-Wahab (Leipzig)^2
1Helios Park-Klinikum Leipzig Klinik für Innere Medizin I - Kardiologie, Angiologie Leipzig, Deutschland; ²Herzzentrum Leipzig - Universität Leipzig Klinik für Innere Medizin/Kardiologie Leipzig, Deutschland; ³HerzZentrum Hirslanden Cardiology Zürich, Schweiz; ⁴Deutsches Herzzentrum der Charite (DHZC) Klinik für Kardiologie, Angiologie und Intensivmedizin | CBF Berlin, Deutschland; ⁵Herz- und Diabeteszentrum NRW Allgemeine und Interventionelle Kardiologie/Angiologie Bad Oeynhausen, Deutschland; ⁶University Hospital Verona Verona, Deutschland; ⁷University Teaching Hospital Klinikum Wels-Grieskrichen Wels, Österreich; ⁸Medizinisches Versorgungszentrum Prof. Mathey, Prof. Schofer Hamburg, Deutschland; ⁹Herzzentrum Dresden GmbH an der TU Dresden Klinik für Innere Medizin, Kardiologie und Intensivmedizin Dresden, Deutschland; ¹⁰De Weezenlanden Hospital Zwolle, Niederlande; ¹¹Inselspital - Universitätsspital Bern Bern, Schweiz; ¹²University hospital Copenhagen Copenhagen, Dänemark

Background: Bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction (BASILICA) effectively prevents coronary artery obstruction (CAO) in patients undergoing transcatheter aortic valve implantation (TAVI). Although the procedure is associated with favorable short-term outcomes, long-term follow-up studies beyond 1-year do not exist. We sought to report outcomes up to 3 years from a multicenter European registry.

Methods: Patients were analyzed from the EURO-BASILICA registry, an ongoing study including patients at high risk for CAO undergoing BASILICA and TAVI. The updated Valve Academic Research Consortium-3 (VARC-3) definitions were used to assess technical and procedural success, safety endpoints at 30 days as well as clinical and echocardiographic outcome up to 3 years.  

Results: This study included 89 patients at high risk for CAO that were treated between August 2018 and October 2021 at 11 European centers. Technical success was 97.8% and procedural success was 87.6%. One- and 3-year survival was 87.4% and 69.2%, respectively, with no significant difference for patients that needed additional coronary stenting during BASILICA (p=0.42). There was no case of late CAO. Coronary angiography during the follow-up period was performed in 3 patients with favorable coronary access in all of them. At 3 years, 70.3% were free from rehospitalization and 67.3% presented with NYHA class I/II. Full echocardiographic follow-up at 3 years was available for 28 patients, which demonstrated peak and mean transvalvular gradients of 21 [17;26] mmHg and 11 [8;17] mmHg, respectively.

Conclusion: BASILICA is an effective method to prevent CAO in patients at high risk undergoing TAVI with promising long-term outcomes, and appears to preserve coronary access for future coronary procedures.