Key result
Simplified UNICORN for TAVR offers potential advantages over BASILICA via enhanced leaflet displacement and simpler procedures.
Why the study?
The UNICORN technique is an emerging leaflet modification strategy for patients at risk for coronary obstruction during TAVR, prompting the description of a simplified procedure in valve-in-valve and native TAVR.
The simplified UNICORN technique represents a potentially advantageous leaflet modification strategy to prevent coronary obstruction during TAVR.
May simplify leaflet modification to prevent coronary obstruction in TAVR; leaves open safety and efficacy pending prospective trials.
OBJECTIVE: The UNICORN (undermining iatrogenic coronary obstruction with radiofrequency needle) technique represents an emerging leaflet modification strategy for patients undergoing transcatheter aortic valve replacement (TAVR) at risk for coronary obstruction. We describe a simplified UNICORN procedure in patients undergoing valve-in-valve and native TAVR. KEY STEPS: This approach employs radiofrequency energy to traverse the base of the prosthetic aortic leaflet, followed by serial balloon inflations to create a large fenestration and subsequent transcatheter heart valve deployment, removing the risk of leaflet obstruction. POTENTIAL PITFALLS: Technical challenges include severely calcified leaflets that impede balloon advancement, the potential for leaflet fragment embolization with resultant coronary artery occlusion, and acute aortic insufficiency after balloon laceration. TAKE-HOME MESSAGE: Compared with BASILICA (bioprosthetic aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction), UNICORN offers potential advantages, including enhanced leaflet tissue displacement and procedure simplification, minimizing the need for wire exchanges and snare retrieval maneuvers.
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Guddeti et al. (2026) studied Patients undergoing transcatheter aortic valve replacement (TAVR) at risk for coronary obstruction. Simplified UNICORN technique vs. BASILICA was evaluated. The simplified UNICORN technique for TAVR offers potential advantages over BASILICA, including enhanced leaflet tissue displacement and procedure simplification.
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