Key result
Modified UNICORN technique prevents coronary obstruction during high-risk native-valve TAVR.
Why the study?
Coronary obstruction from calcified native leaflet displacement is a life-threatening complication of TAVR, prompting adaptation of the UNICORN technique to native valves.
Does the modified UNICORN technique prevent iatrogenic coronary obstruction during native-valve TAVR in patients with bulky leaflet calcification?
Case Report (n=1)
Does the modified UNICORN technique prevent iatrogenic coronary obstruction during native-valve TAVR in patients with bulky leaflet calcification?
The modified UNICORN TAVR technique may serve as a feasible and safe alternative to BASILICA to prevent iatrogenic coronary artery obstruction in patients undergoing native-valve TAVR with bulky leaflet-tip calcification.
May support modified UNICORN as alternative to BASILICA in select native TAVR cases; leaves open comparative safety and efficacy.
OBJECTIVE: Coronary obstruction due to displacement of calcified native valve leaflets over the coronary ostia is a life-threatening complication of transcatheter aortic valve replacement (TAVR). Undermining iatrogenic coronary obstruction with radiofrequency needle (UNICORN) has emerged as an innovative electrosurgical method for preventing coronary obstruction, primarily in valve-in-valve TAVR. A native-valve modification is described. KEY STEPS: First, the target leaflet is traversed using transcatheter electrosurgery with angiographic and echocardiographic guidance. Then a series of balloon valvotomies are performed followed by leaflet laceration with a large noncompliant balloon before implantation of the balloon-expandable transcatheter heart valve. POTENTIAL PITFALLS: Malalignment in traversing the target aortic leaflet can lead to ineffective splay or damage to nearby structures. TAKE-HOME MESSAGE: The modified UNICORN TAVR technique is an alternative to bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction when bulky leaflet calcification is present at the leaflet tip, while also preserving superior coronary access compared with the snorkel technique.
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Nallapati et al. (2026) conducted a case report in Severe symptomatic calcific aortic stenosis (n=1). Modified UNICORN technique was evaluated on Coronary patency post-valve deployment. The modified UNICORN technique successfully prevented iatrogenic coronary artery obstruction during native-valve transcatheter aortic valve replacement in a patient with bulky leaflet calcification.
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