BASILICA Technique: Why, When and How?

Coronary artery obstruction is a commonly fatal complication occurring after transcatheter aortic valve replacement. The main mechanisms are displacement of valve leaflets to overlie the coronary ostium or sequestration of the coronary sinus. The bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction (BASILICA) procedure mitigates this risk. It entails deliberate laceration of the valve leaflet to allow it to splay apart during transcatheter heart valve implantation, thus maintaining coronary perfusion. Patient selection is based on key anatomical and imaging-derived parameters. Catheter electrosurgery involves using electrified wires to permit puncture and laceration of the leaflet. The steps undertaken to achieve a successful BASILICA procedure include access, traversal, puncture, laceration and completion, which are described in this review. Challenges faced by the BASILICA operator and practical solutions are also discussed.