Key result
UNICORN technique modifies target leaflets to prevent coronary obstruction during valve-in-valve TAVR.
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The UNICORN technique provides a procedural approach to mitigate the risk of coronary obstruction during valve-in-valve transcatheter aortic valve replacement.
The UNICORN (undermining iatrogenic coronary obstruction with radiofrequency needle) technique was developed in 2022 to reduce the risk for coronary obstruction during valve-in-valve transcatheter aortic valve replacement. The procedure involves traversing the target leaflet with an electrified wire, followed by serial dilation with coronary and peripheral balloons. A balloon-expandable valve is then delivered into the de novo fenestration for intraleaflet deployment. As the balloon-expandable valve expands, the target leaflet is opened and displaced away from the at-risk coronary ostium, resulting in a minimal neoskirt on the target side. Since its introduction, the technique has been adopted at numerous centers worldwide, with various modifications and adaptations. In this paper, a step-by-step description of the UNICORN procedure is provided, and troubleshooting strategies for potential challenges are discussed.
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Chan et al. (2026) conducted a review in Failed aortic bioprosthesis at risk for coronary obstruction during valve-in-valve TAVR. UNICORN (undermining iatrogenic coronary obstruction with radiofrequency needle) technique was evaluated. The UNICORN technique provides a step-by-step procedural approach to modify the target leaflet and reduce the risk of coronary obstruction during valve-in-valve transcatheter aortic valve replacement.
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