TABLE 5.
Advantages and Disadvantages of BASILICA
| Advantages of BASILICA | Disadvantages of BASILICA |
|---|---|
| Conceptually simple | Has many unfamiliar steps; can be difficult in practice Not suitable for coronary obstruction caused by TAVR fabric skirt or by TAVR commissure Not suitable for most TAVR-in-TAVR |
| Does not leave behind a deformable or prothrombotic stent implant, such as “snorkel” stent | Laceration may not be completely aligned with coronary ostium, as in “sinus deficiency” mechanism of coronary obstruction |
| Relatively straightforward for “sinus sequestration” mechanism of coronary obstruction | More demanding for “sinus deficiency” mechanism of coronary obstruction |
| Relatively straightforward for LCC | Relatively challenging for RCC because of difficult projection angles |
| If a leaflet can be traversed, it almost always can be lacerated | Not suitable for bulky calcific leaflet nodules, which can cause coronary obstruction by mass effect |
| Confidence in need for BASILICA is high when VTC distance is low (<3 mm) | Poor specificity in predicting risk (need for BASILICA) when VTC distance is low but ≥3 mm |
| Applicable to native as well as bioprosthetic aortic valve failure | Technically demanding in stentless aortic bioprostheses |
| Can be achieved using off-the-shelf catheter tools | Would benefit from purpose-built commercial catheter tools |
| Speculation that it improves flow patterns and reduces stasis both in sinuses and neosinuses of Valsalva | Strokes observed in prospective BASILICA IDE protocol |
| Attractive for patients who are at high risk for surgical aortic valve replacement | Less desirable choice for patients who are low or intermediate risk for surgical aortic valve replacement |
| Can be planned on CT | Should not be planned on angiography or echocardiography alone |
| Can be performed using moderate sedation and fast-track discharge | Requires extra “hands” for the actual laceration and may benefit from adjunctive transesophageal echocardiographic guidance |
| Avoids indefinite dual-antiplatelet therapy required after “snorkel” stenting | |
| Improved future coronary access |