Leaflet Modification: Basilica, Shortcut, and the Future of Coronary Protection with Dr. Toby Rogers and Dr. Andrei Pop

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 proceduresHow Shortcut and Telltale are changing training and accessWhy leaflet modification is still primarily for TAV-in-SAV but expanding to redo-TAVRBalancing risk, complexity, and informed consent for lower-risk patientsRole of CT simulation, FEops, and DASI modeling for lifetime valve planningWhen to err on the side of leaflet modification vs risking coronary obstructionCoronary height and valve-to-coronary distance — why those 2–4mm cutoffs aren’t gospelFuture directions: routine modification, improved washout, and potential HALT reductionAccess routes (carotid, transcaval, axillary) and practical tips for operatorsComparing BASILICA, Shortcut, Unicorn, and Telltale—safety, mechanism, and learning curveWhy new devices need structured trials before widespread useThis is essential viewing for structural heart operators refining TAVR-in-TAVR safety, coronary access strategies, and the future of leaflet modification.🔔 Subscribe for more insights from interventional experts and real-world program builders.📱 Download the app: https://apps.apple.com/app/apple-store/id1586692687📺 Follow us on YouTube: https://www.youtube.com/channel/UCfrLYhAhliQ2ZvXinkDCZvAChapters: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