RESUMO
Transcatheter aortic valve implantation (TAVI) to treat patients with severe symptomatic aortic stenosis is a well-established procedure. Even though cases series have reported TAVI use in high-risk patients with pure native aortic regurgitation, this is still considered an off-label intervention, especially when the aortic annulus dimensions are beyond the recommended by prosthesis manufacturers. Herein, we provide an updated review regarding the transcatheter treatment of pure native aortic regurgitation and illustrate this issue by presenting a clinical case of a patient with pure aortic regurgitation and a large aortic annulus who received a self-expanding non-dedicated transcatheter heart valve.
RESUMO
Transcatheter aortic valve implantation (TAVI) to manage structural bioprosthetic valve deterioration has been successful in mitigating the risk of a redo cardiac surgery. However, TAVI-in-TAVI is a complex intervention, potentially associated with feared complications such as coronary artery obstruction. Coronary obstruction risk is especially high when the previously implanted prosthesis had supra-annular leaflets and/or the distance between the prosthesis and the coronary ostia is short. The BASILICA technique (bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction) was developed to prevent coronary obstruction during native or valve-in-valve interventions but has now also been considered for TAVI-in-TAVI interventions. Despite its utility, the technique requires a not so widely available toolbox. Herein, we discuss the TAVI-in-TAVI BASILICA technique and how to perform it using more widely available tools, which could spread its use.
