Apollo Hospitals Greams Road reported the treatment of a 67-year-old patient with heart disease using a BASILICA-assisted Transcatheter Aortic Valve Implantation procedure to prevent complications during valve replacement.
The procedure was carried out by a cardiac team led by Dr Sengottuvelu G, Senior Interventional Cardiologist and Clinical Lead of Structural Heart Interventions at Apollo Hospitals. The approach is used for patients who are not suited for repeat open-heart surgery and provides an alternative in redo valve cases.
The patient had a medical history including diabetes, coronary artery disease with prior stent placement, and a surgical aortic valve replacement in 2017 for bicuspid aortic stenosis. The artificial valve later deteriorated, leading to aortic stenosis and aortic regurgitation, requiring further treatment.
Imaging before the procedure showed that the coronary arteries were located close to the existing valve. In such cases, placing a new valve can push the valve leaflet into the arteries and block blood flow.
To address this, the team performed a TAVI procedure, where a new valve is delivered through a blood vessel, usually via the leg. Due to the risk of coronary obstruction, the procedure was combined with the BASILICA technique to prevent blockage.
Dr Sengottuvelu G, Senior Interventional Cardiologist and Clinical Lead of Structural Heart Interventions, Apollo Hospitals Chennai, said, “This case highlights the evolving capabilities of transcatheter therapies in managing highly complex structural heart disease. BASILICA is a technically demanding procedure, and its successful execution reflects the expertise and coordination of our team.”
During the procedure, a wire was positioned across the valve leaflet that posed the risk. Using electrical energy, the team split the leaflet. When the new valve was placed, the divided leaflet moved aside, allowing blood flow to the coronary arteries.
Guidewires were placed in both coronary arteries, with backup stents kept ready for use if required to restore blood flow.
Dr C S Muthukumaran, Interventional Cardiologist, Apollo Hospitals Chennai, added, “Performing the first BASILICA procedure in the Apollo Group is a proud moment. It reinforces our commitment to bringing cutting-edge, life-saving technologies to patients in India.”
Following the procedure, a transcatheter heart valve was implanted. The patient showed improved blood flow, no obstruction to the coronary arteries, stable heart rhythm, and was discharged in a stable condition.
Coronary artery obstruction during TAVI occurs in less than 1 per cent of cases but carries a mortality risk of up to 40–50 per cent. Techniques such as BASILICA have been developed for such cases, with reported success rates exceeding 90 per cent in international studies. The procedure is specialised and is not widely performed in India.