threatening complication in high-risk heart patient

Apollo Hospitals, Greams Road, Chennai has successfully treated a high-risk 67-year- old patient with complex heart disease using a rare BASILICA-assisted Transcatheter Aortic Valve Implantation (TAVI) procedure, helping prevent a potentially life-threatening complication during valve replacement. The advanced minimally invasive procedure was carried out by a multidisciplinary cardiac team led by Dr. Sengottuvelu G, Senior Interventional Cardiologist and the Clinical Lead of Structural Heart Interventions, Apollo Hospitals. This approach is particularly relevant for patients who are not ideal candidates for repeat open-heart surgery, offering a less invasive alternative in complex redo valve cases. The patient presented a complicated medical history, including diabetes, coronary artery disease with prior stent placement, and a previous surgical aortic valve replacement in 2017 for bicuspid aortic stenosis. Over time, the artificial valve deteriorated, leading to severe aortic stenosis and moderate aortic regurgitation, resulting in recurring symptoms and the need for further intervention. Pre-procedure imaging revealed a critical challenge. The coronary arteries, which supply blood to the heart, were located very close to the existing valve. In such cases, placing a new valve can push the valve leaflet into these arteries, potentially blocking blood flow and leading to life-threatening complications. To address this, the team performed a minimally invasive TAVI procedure, where a new valve is delivered through a blood vessel, typically via the leg. Given the high risk of coronary obstruction, this was combined with the BASILICA technique, an advanced method designed to prevent blockage. Dr. Sengottuvelu G, Senior Interventional Cardiologist and Clinical Lead of Structural Heart Interventions, Apollo Hospitals Chennai, said, &quot;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 fine wire was carefully positioned across the valve leaflet that posed the risk. Using a controlled burst of electrical energy, the team precisely split the leaflet. Once divided, the two halves move aside when the new valve is placed, ensuring that blood flow to the coronary arteries is not obstructed. As an added layer of safety, guidewires were placed in both coronary arteries, with backup stents kept ready for immediate use, ensuring that blood flow could be restored instantly if required. 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, the team successfully implanted a transcatheter heart valve, achieving an excellent clinical outcome. The patient showed improved blood flow through the valve, no obstruction to the coronary arteries, stable heart rhythm, and has since been discharged in a stable condition. While coronary artery obstruction during TAVI is rare (occurring in less than 1% of cases), it carries a high mortality risk of up to 40–50%, making prevention critical. Techniques such as BASILICA have been developed globally for such high-risk cases, with success rates exceeding 90% in international studies. However, the procedure remains highly specialised and is not widely performed, particularly in India. This case reflects the growing role of advanced structural heart interventions in managing complex cardiac conditions, while reducing the need for repeat open surgeries and enabling faster recovery for patients.