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Article Abstract
Background: The Lotus valve is a mechanically expanded transcatheter heart valve with design features that pose challenges for valve-in-valve transcatheter aortic valve replacement (ViV-TAVR). Performing BASILICA (bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction during TAVR) to modify the Lotus leaflets has only been reported in benchtop models.
First-in-human/early Reports Summary: A 79-year-old woman with a degenerated 23-mm Lotus transcatheter heart valve and high risk of coronary occlusion underwent BASILICA, followed by implantation of a 26-mm Evolut FX valve. Conservative postdilation was performed to optimize valve expansion while minimizing risk of unraveling the Lotus frame.
Discussion: Although the Lotus valve has a low profile, valve canting and a high implant are risk factors for sinus sequestration with ViV-TAVR. This case demonstrates BASILICA's feasibility and key procedural adaptations required for success.
Novelty: First-in-human report of BASILICA to prevent coronary obstruction before ViV-TAVR in a Lotus transcatheter heart valve.
Take-home Messages: BASILICA can mitigate coronary obstruction risk before ViV-TAVR inside a Lotus valve. Conservative postdilation can achieve excellent hemodynamics while preserving frame integrity.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC12371379 | PMC |
| http://dx.doi.org/10.1016/j.jaccas.2025.104669 | DOI Listing |
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