The BASILICA procedure is an innovative, minimally invasive cardiac intervention designed to prevent a potentially fatal complication of TAVR: Coronary artery obstruction.

When implanting a new valve (TAVR) into a diseased native valve or another bioprosthetic valve (valve-in-valve), the leaflets of the old valve can block the openings (ostia) of the coronary arteries.

Uses electrosurgery to intentionally cut (lacerate) the aortic leaflet, creating space for the new valve and ensuring the leaflet parts splay open, allowing blood flow to the coronaries.

In cases of rigid or calcified leaflets, a balloon is used to dilate the traversal area immediately before laceration to augment leaflet splaying and ensure a more complete split.

This technique is considered a potentially simpler and faster alternative to BASILICA. It uses electrosurgery for initial access to the leaflet, followed by balloon inflation to physically tear and reposition the leaflet tissue. However, it can lead to acute AR and might need mechanical support if there is a delay in valve deployment.

There are variations- LLAMACORN, CATHEDRAL etc. The goal of all these modifications is the same: to create an effective, controlled and adequate split in the aortic leaflet so that the new transcatheter heart valve can be safely implanted, preserving blood flow to the coronary arteries.