Aortic Valve Leaflet Modification: A Working Group Position Statement on Best Practices and Step-by-Step Guide

Authors

• Toby Rogers
• Rim N Halaby
• Adam B Greenbaum
• Christopher G Bruce
• Vasilis C Babaliaros
• Jaffar M Khan
• Mohamed Abdel-Wahab
• Matti Adam
• Nicholas S Amoroso
• Ole de Backer
• Israel M Barbash
• Isida Byku
• Kwong-Yue Eric Chan
• Adnan K Chhatriwalla
• Christine J Chung
• James Cockburn
• Jeremiah P Depta
• David Elison
• Marvin Eng
• Jason R Foerst
• Phillip Freeman
• David Hildick-Smith
• Amar Krishnaswamy
• Roger J Laham
• Simon C Lam
• M Azeem Latib
• Paul D Mahoney
• James M McCabe
• Kamran Muhammad
• Emily M Perdoncin
• Karl K Poon
• Andrei M Pop
• Mark J Ricciardi
• Jeremy Rier
• John T Saxon
• Stephanie Sellers
• Puvi N Seshiah
• Pinak B Shah
• Pedro Villablanca, Henry Ford HealthFollow
• Brian K Whisenant
• Chun-Ka Wong
• Pradeep K Yadav
• D Korel Yildirim
• Robert J Lederman

Recommended Citation

Rogers T, Halaby RN, Greenbaum AB, Bruce CG, Babaliaros VC, Khan JM, Abdel-Wahab M, Adam M, Amoroso NS, de Backer O, Barbash IM, Byku I, Chan KE, Chhatriwalla AK, Chung CJ, Cockburn J, Depta JP, Elison D, Eng M, Foerst JR, Freeman P, Hildick-Smith D, Krishnaswamy A, Laham RJ, Lam SC, Latib MA, Mahoney PD, McCabe JM, Muhammad K, Perdoncin EM, Poon KK, Pop AM, Ricciardi MJ, Rier J, Saxon JT, Sellers S, Seshiah PN, Shah PB, Villablanca PA, Whisenant BK, Wong CK, Yadav PK, Yildirim DK, Lederman RJ. Aortic Valve Leaflet Modification: A Working Group Position Statement on Best Practices and Step-by-Step Guide. JACC Cardiovasc Interv. 2026;19(11):1347-1377.

Document Type

Article

Publication Date

6-8-2026

Publication Title

JACC Cardiovasc Interv

Keywords

Humans, Aortic Valve, Aortic Valve Stenosis, Bioprosthesis, Consensus, Coronary Stenosis, Electrosurgery, Heart Valve Prosthesis, Prosthesis Design, Risk Assessment, Risk Factors, Transcatheter Aortic Valve Replacement, Treatment Outcome

Abstract

Coronary artery obstruction is a potential life-threatening complication of transcatheter aortic valve replacement (TAVR) in all settings including native, valve-in-valve, and redo-TAVR. Risk of obstruction can be identified on preprocedural computed tomography. BASILICA (bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction) effectively prevents TAVR-induced coronary obstruction. Perceived technical complexity, limited availability of purpose-built devices, and scarce training opportunities have hindered the adoption of BASILICA and related techniques. This document synthesizes international experience to provide contemporary best-practice guidance for BASILICA and related leaflet modification strategies. This state-of-the-art review details transcatheter electrosurgery principles; how to determine risk and computed tomographic risk analysis and plan the procedures; a step-by-step guide to electrosurgical BASILICA; tips and tricks for uncommon challenges; scenarios in which BASILICA is unlikely to succeed; and variant techniques such as intraleaflet valve deployment, alternative measures, and dedicated devices. These contemporary best practices can help operators gain or maintain proficiency.

Medical Subject Headings

Humans; Aortic Valve; Aortic Valve Stenosis; Bioprosthesis; Consensus; Coronary Stenosis; Electrosurgery; Heart Valve Prosthesis; Prosthesis Design; Risk Assessment; Risk Factors; Transcatheter Aortic Valve Replacement; Treatment Outcome

PubMed ID

42264628

Volume

19

Issue

11

First Page

1347

Last Page

1377