BICORN (Bilateral Iatrogenic Coronary Obstruction Risk Nullification) Procedure for Transcatheter Aortic Valve-in-Valve Replacement

We describe a bilateral coronary leaflet modification technique that involves translocation of degenerated transcatheter valve leaflets before placement of valve-in-valve, named Bilateral Iatrogenic Coronary Obstruction Risk Nullification (BICORN). Key steps include the following: 1) Electrified 0.014-in ASTATO wires were traversed through the base of the right and left coronary leaflets of preexisting CoreValve, which were then swapped with 0.035-in wires; 2) Using peripheral balloons, leaflet traversal points were appropriately dilated; 3) A 26-mm Sapien valve was then advanced over the wire through the left coronary leaflet to the ascending aorta in a deployment-ready state; and 4) Right coronary leaflet was then translocated with 18-mm True balloon followed by deployment of the Sapien valve lined up to sixth node of the CoreValve. Translocation of preexisting valve leaflets is an uncontrolled step and can potentially lead to distal embolization and or severe aortic valve insufficiency. BICORN can be considered as an option for transcatheter aortic valve in transcatheter aortic valve replacement in patients with extreme surgical risk.