Leaflet modification has rapidly evolved from niche innovation to a cornerstone of lifetime TAVR management.
In this discussion, Dr. Toby Rogers joins Dr. Andrei Pop to explore the latest data, device advances, and clinical decision-making behind Basilica, Shortcut, and emerging techniques like Telltale, Unicorn, and leaflet excision.
Key topics covered:
History of leaflet modification — from LAMPOON to BASILICA and now device-guided procedures
How Shortcut and Telltale are changing training and access
Why leaflet modification is still primarily for TAV-in-SAV but expanding to redo-TAVR
Balancing risk, complexity, and informed consent for lower-risk patients
Role of CT simulation, FEops, and DASI modeling for lifetime valve planning
When to err on the side of leaflet modification vs risking coronary obstruction
Coronary height and valve-to-coronary distance — why those 2–4mm cutoffs aren’t gospel
Future directions: routine modification, improved washout, and potential HALT reduction
Access routes (carotid, transcaval, axillary) and practical tips for operators
Comparing BASILICA, Shortcut, Unicorn, and Telltale—safety, mechanism, and learning curve
Why new devices need structured trials before widespread use
This is essential viewing for structural heart operators refining TAVR-in-TAVR safety, coronary access strategies, and the future of leaflet modification.
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Chapters:
00:00 – Introduction: The evolution of leaflet modification
00:40 – From LAMPoon to BASILICA: history of electrosurgery
02:00 – Off-label origins and why it mattered
03:00 – Shortcut and Telltale: first commercial systems
05:00 – Who qualifies? High-risk vs lower-risk considerations
06:30 – Lifetime management and early valve planning
08:00 – Simulation tools (3Mensio, FEops, DASI) in valve strategy
09:30 – Challenges in coronary height and valve-to-coronary measurement
12:00 – Surgical perspective: root enlargement and small annuli
13:00 – Rethinking the “risk-based” TAVR vs SAVR decision
15:00 – When to err toward leaflet modification
17:00 – New benefits beyond obstruction: access & flow dynamics
19:00 – Routine modification in the future?
20:00 – Cerebral protection data and operator practices
23:00 – Access routes: transfemoral vs transcarotid approaches
25:00 – Comparing BASILICA, Shortcut, Unicorn & Telltale
28:00 – Risks of balloon-tear methods and lack of validation
30:00 – Data-driven advancement vs anecdotal adoption
31:00 – Future of device design and mitral implications
33:00 – Closing remarks and next frontier: mitral leaflet work
#LeafletModification #BASILICA #Shortcut #Telltale #TAVRinTAVR #ValveinValve
#StructuralHeart #CoronaryProtection #AorticValve #MurmurMD