Impact of BASILICA on Sinus and Neo-Sinus Hemodynamics after Valve-in-Valve with and without Coronary Flow

Background/purpose: This study aims at evaluating the impact of BASILICA on neo-sinus and sinus hemodynamics with and without coronary flow. Leaflet thrombosis after valve-in-valve (ViV) may compromise not only leaflet mobility but also affect valve durability and performance. Methods/materials: In a 23 mm transparent surgical aortic valve model, a 23 mm Edwards SAPIEN 3 and a 26 mm Medtronic Evolut were deployed before and after leaflet laceration, in models with and without coronary flow. Neo-sinus and sinus hemodynamics were evaluated in the aortic position of a pulse duplicator and particle image velocimetry was performed in order to quantify sinus flow hemodynamics along with sinus and neosinus washout. Results: BASILICA-type leaflet laceration procedure led to (a) an increase in the velocities in the sinus and the neo- sinus by 50% for Evolut ViV with and without coronary flow, 70% for non-coronary SAPIEN 3 ViV and 10% for coronary SAPIEN 3 ViV, and (b) an improvement in overall washout up to 2 cycles in the neo-sinus and 0.5 cycles in the sinus. Conclusions: A BASILICA-type leaflet laceration approach may improve sinus and neo-sinus hemodynamics through decreasing flow stasis and enabling less confined blood flow. BASILICA confers coronary sinus flow pat- terns to the non-coronary sinus. (c) 2019 Elsevier Inc. All rights reserved.