Multicenter Experience of Aortic Valve Leaflet Modification in TAVR

BACKGROUND: Safety and efficacy of leaflet modification in transcatheter aortic valve replacement (TAVR) to reduce coronary obstruction risk have been demonstrated in North American and European populations, but real-world data from the Asia-Pacific remain limited. OBJECTIVES: The authors aimed to report the real-world procedural and clinical outcomes of bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction (BASILICA) and undermining iatrogenic coronary obstruction with radiofrequency needle (UNICORN) leaflet modification techniques during TAVR in Asia-Pacific. METHODS: This multicenter retrospective observational registry included consecutive patients undergoing aortic valve leaflet modification during TAVR across 7 centers in the Asia-Pacific from April 2019 to January 2026. Primary outcome was procedural success, defined as successful leaflet traversal, leaflet modification, and transcatheter heart valve implantation without coronary obstruction, emergent surgery, stroke, or mortality in 30 days. Secondary outcomes included 30-day major adverse events per the Valve Academic Research Consortium 3 definitions. RESULTS: Among 100 patients, 72.2% were female with a median age of 80.0 years. BASILICA was performed in 67.0%, UNICORN in 30.0%, and BASILICA-UNICORN in 3.00%. Annual case volume increased nearly 10-fold during the study period. Index valves were predominantly small (≤21 mm) surgical bioprostheses. Procedural success was achieved in 85.1% of BASILICA patients and 96.7% of UNICORN patients. Coronary obstruction occurred in 2.99% of BASILICA patients. CONCLUSIONS: Transcatheter electrosurgical leaflet modification techniques are associated with acceptable short-term outcome in high-risk patients undergoing TAVR in the Asia-Pacific region.