Abstract
BACKGROUND: The Lotus valve is a mechanically expanded transcatheter heart valve with design features that pose challenges for valve-in-valve transcatheter aortic valve replacement (ViV-TAVR). Performing BASILICA (bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction during TAVR) to modify the Lotus leaflets has only been reported in benchtop models. FIRST-IN-HUMAN/EARLY REPORTS SUMMARY: A 79-year-old woman with a degenerated 23-mm Lotus transcatheter heart valve and high risk of coronary occlusion underwent BASILICA, followed by implantation of a 26-mm Evolut FX valve. Conservative postdilation was performed to optimize valve expansion while minimizing risk of unraveling the Lotus frame. DISCUSSION: Although the Lotus valve has a low profile, valve canting and a high implant are risk factors for sinus sequestration with ViV-TAVR. This case demonstrates BASILICA's feasibility and key procedural adaptations required for success. NOVELTY: First-in-human report of BASILICA to prevent coronary obstruction before ViV-TAVR in a Lotus transcatheter heart valve. TAKE-HOME MESSAGES: BASILICA can mitigate coronary obstruction risk before ViV-TAVR inside a Lotus valve. Conservative postdilation can achieve excellent hemodynamics while preserving frame integrity.