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Multicenter Study
. 2024 Mar 25;17(6):742-752.
doi: 10.1016/j.jcin.2024.01.007.

Chimney Stenting vs BASILICA for Prevention of Acute Coronary Obstruction During Transcatheter Aortic Valve Replacement

Antonio Mangieri  1 , Ines Richter  2 , Mauro Gitto  3 , Ahmed Abdelhafez  2 , Francesco Bedogni  4 , Jonas Lanz  5 , Matteo Montorfano  6 , Axel Unbehaun  7 , Francesco Giannini  8 , Roberto Nerla  8 , Maurizio Taramasso  9 , Alfonso Ielasi  10 , Tanja Rudolph  11 , Marco Ferlini  12 , Flavio Ribichini  13 , Enrico Poletti  4 , Azeem Latib  14 , Antonio Colombo  3 , Nicolas M Van Mieghem  15 , Holger Thiele  2 , Mohamed Abdel-Wahab  16
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Free article
Multicenter Study

Chimney Stenting vs BASILICA for Prevention of Acute Coronary Obstruction During Transcatheter Aortic Valve Replacement

Antonio Mangieri et al. JACC Cardiovasc Interv. .
Free article

Abstract

Background: Coronary obstruction (CO) is a potentially life-threatening complication of transcatheter aortic valve replacement (TAVR). Chimney stenting or leaflet laceration with transcatheter electrosurgery (Bioprosthetic or Native Aortic Scallop Intentional Laceration to Prevent Iatrogenic Coronary Artery Obstruction [BASILICA]) are 2 techniques developed to prevent CO.

Objectives: The aim of the present study was to compare periprocedural and 1-year outcomes of chimney and BASILICA in TAVR patients at high risk of CO.

Methods: This multicenter observational registry enrolled consecutive TAVR patients at high risk of CO, undergoing either preventive chimney stenting or BASILICA. Clinical success was defined as successful performance of the chimney or BASILICA technique without clinically relevant ostial CO. The primary endpoint was major adverse cardiovascular events, a composite of death, myocardial infarction, stroke, or unplanned target lesion coronary revascularization at 1 year.

Results: A total of 168 patients were included: 71 (42.3%) received chimney stenting, and 97 (57.7%) underwent BASILICA. Patients undergoing BASILICA had higher preprocedural risk of CO, as indicated by lower sinotubular junction height (18.2 ± 4.8 mm vs 14.8 ± 3.4 mm; P < 0.001) and diameter (28.2 ± 4.5 vs 26.8 ± 3.4; P = 0.029). Rates of periprocedural complications were similar between the 2 groups. Clinical success was 97.2% and 96.9% in chimney and BASILICA, respectively (P = 0.92). At 1-year follow-up, the cumulative incidence of major adverse cardiovascular events was 18.7% (95% CI: 11%-30.6%) in the chimney group and 19.9% (95% CI: 12.1%-31.5%) in the BASILICA group (log-rank P = 0.848), whereas chimney was associated with a numerically higher cardiovascular mortality than BASILICA (6.7% vs 1.3%; log-rank P = 0.168).

Conclusions: Chimney stenting and BASILICA effectively prevent TAVR-induced acute CO. Both techniques seem to have comparable acceptable periprocedural and 1-year outcomes.

Keywords: chimney stenting; coronary obstruction; leaflet modification; snorkel stenting; transcatheter aortic valve replacement.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Mangieri serves as a proctor for Kardia; has received speaker fees from Boston Scientific, Abbott Vascular, and Edwards Lifesciences; and has received institutional grants from Boston Scientific and Abbott Vascular. Dr Montorfano has received consultant fees from Abbott, Boston, Kardia, and Medtronic. Dr Latib is a consultant and serves on advisory boards for Boston Scientific, Edwards Lifesciences, Medtronic, Abbott, and Philips. Dr Van Mieghem has received research grants from Abbott Vascular, Biotronik, Boston Scientific, Edwards Lifesciences, Medtronic, Daiichi-Sankyo, AstraZeneca, and Pie Medical; and has received advisory board/consultancy fees from Anteris, JenaValve, Amgen, Materialise, Siemens, Abbott Vascular, Biotronik, Boston Scientific, Medtronic, and Daiichi-Sankyo. Prof Abdel-Wahab declares that his hospital receives speaker honoraria and/or consultancy fees on his behalf from Boston Scientific, Medtronic, and Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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