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. Author manuscript; available in PMC: 2020 Jan 8.
Published in final edited form as: JACC Cardiovasc Interv. 2019 Jul 8;12(13):1197–1216. doi: 10.1016/j.jcin.2019.04.052

TABLE 4.

Equipment Required to Perform BASILICA

Stage and Device Comment
Access
 Suture femoral closure device (such as Perclose ProGlide, Abbott)

  • Up to 4 are used for a transfemoral doppio BASILICA.
 Sheath: DrySeal Flex 14-22 F × 33 cm (W.L. Gore)

  • Allows multiple parallel catheters without significant bleeding. Two can be used for doppio BASILICA.

  • 14-F allows three simultaneous 6-F catheters.

  • 16-F allows larger crossing guide catheters.

  • 18-, 20-F allows Evolut R, PRO. 22-F allows transcaval 23S3.
 Sheath: eSheath (Edwards Lifesciences)

  • Placed after BASILICA laceration for SAPIEN 3 TAVR.
 Sheath: large Check-Flo Performa 18-20 F (Cook)

  • For Medtronic CoreValve Evolut R or PRO.
Targeting and traversal
 Single-loop snare: 20-30 mm (Amplatz Goose Neck, Medtronic)

  • For guidewire capture. Sized 1:1 to LVOT. Used inside a guiding catheter + locking Touhy-Borst hemostatic valve + stopcock.

  • Retain the small snare loader to externalize the ensnared guidewire.
 Guidewire: 0.018-inch stiff (such as V-18, Boston Scientific) or 0.014-inch stiff (such as Spartacore, Abbott) anchor guidewire

  • Use as anchor guidewire alongside snare through LVOT catheter.

  • Insert it using a locking Tuohy-Borst rotating hemostatic valve + stopcock.
 Snare guiding catheter: multipurpose or R Judkins, 6 F × 100 cm (vendor agnostic)

  • Used in tandem with Goose Neck snare, Tuohy + stopcock.
 For left leaflet (in order of preference): AL2, AL3, AL4, EBU3.75, EBU4, EBU5 guiding catheters, 7- to 8-F × 100 cm (vendor agnostic)

  • Directs crossing system + Tuohy + stopcock.

  • New curves appear helpful.
 New “pachyderm” curves: PAL1, PAL2, PAL3 (Launcher, Medtronic)
 For right leaflet (in order of preference): JR4, MP, IM, AR1 guiding catheters, 7- to 8-F × 100 cm (vendor agnostic)

  • Directs crossing system + Tuohy + stopcock.

  • New curves appear helpful.
 New “pachyderm” curve: PJR4 (launcher, Medtronic)
 Internal mammary (IM) curve diagnostic catheter, 5-F × 125 cm length (e.g., EXPO or Impulse, Boston Scientific)

  • Mandatory device (not commonly stocked) used inside 6- to 8-F traversal guide to impart additional curve/reach.
 Insulating polymer jacket (hubless locking 0.014-inch microcatheter) (Piggyback wire converter, 145 cm, Teleflex)

  • Mandatory device. Do not substitute.

  • Fundamental component of coaxial BASILICA traversal and laceration system, mounted over Astato-XS. One per leaflet.

  • Sites are advised to stock extras.

  • Alternative conventional 0.014-inch microcatheters having hubs are unsatisfactory.
 Stiff 0.014 inch × 300 cm guidewire (Astato XS 20, Asahi-Intecc)

  • Mandatory device. Do not substitute.

  • Fundamental component of coaxial BASILICA electrosurgery system, mounted inside Piggyback. One per leaflet.

  • Short wires do not allow laceration after traversal.

  • Sites are advised to stock extras.
Laceration
 Electrosurgery pencil and dispersive electrodes

  • Bare (noninsulated) electrosurgery pencils are preferred. Clear polymer coating (e.g., EDGE, Medtronic) prevents electrical connection to guidewire unless it is stripped.
 Needle driver

  • To connect back end of Astato to electrosurgery pencil.
 Scalpel blade such as #11

  • To scrape insulation from back (proximal) end of Astato guidewire.

  • To denude focally the laceration surface on the Astato guidewire shaft.

  • To strip polymer coating from affected electrosurgery pencils.
Electrosurgery generator (e.g., Valleylab Force/FX, Medtronic)
 Torquers 0.014 inch

  • Three per leaflet. Apply 2 on LVOT (snare guide) side of laceration wire. One abuts the Piggyback on aortic (traversal) catheter side, to lock its position on the guidewire.
 Torquers 0.035 inch

  • One per leaflet. Apply over the Piggyback on the aortic (traversal) catheter side, to secure its position on the guidewire.
 60-ml luer lock syringes each with 12- to 24-inch extension tubing.

  • Two per leaflet. Fill with 5% dextrose in water (not saline) and connect to stopcock on both BASILICA catheters. Flood the field with dextrose during laceration to displace all blood.
 6-F angled pigtail

  • Position in ventricle during laceration to allow rapid conversion to TAVR guidewire, sheath, and TAVR device in case of BASILICA-induced hemodynamic deterioration.

LVOT = left ventricular outflow tract; other abbreviations as in Table 1.