3D Intracardiac Echocardiography-Guided BASILICA Transcatheter Aortic Valve Replacement Under Conscious Sedation

A 67-year-old man was emergently transferred from another hospital with severe aortic stenosis, acute heart failure (left ventricular ejection fraction: 23%), cardiogenic shock on high-dose inotropic support (SCAI Shock Stage D), respiratory failure on high-flow nasal cannula 60 L/min with oxygen fraction 0.6, for escalation of care. The Heart Team deemed the patient to be at very high surgical risk. Right heart catheterization was not performed due to clinical emergency status. However, the patient was also deemed high risk coronary status for TAVR with a low-lying native left main coronary artery (height: 4.9 mm, valve-to-coronary distance: 6.1 mm, with a need to oversize the simulated valve), and risk of left sinus sequestration (valve-to-sinotubular junction distance: 1.6mm)(Figure 1).