Key result
IVUS-guided UNICORN leaflet modification during TAVR-in-TAVR yields excellent outcomes despite high risk of coronary obstruction.
Why the study?
Coronary obstruction is a rare but potentially fatal complication of TAVR, especially during valve-in-valve and TAVR-in-TAVR procedures, and leaflet modification techniques have emerged to reduce this risk.
Case Report (n=1)
IVUS-guided UNICORN leaflet modification is a feasible technique to improve procedural precision and prevent coronary obstruction during high-risk TAVR-in-TAVR procedures.
BACKGROUND: Coronary obstruction is a rare but potentially fatal complication of transcatheter aortic valve replacement (TAVR), particularly during valve-in-valve and TAVR-in-TAVR procedures. Leaflet modification techniques have emerged to reduce this risk. CASE SUMMARY: A 67-year-old woman with severe degeneration of a 26-mm SAPIEN 3 transcatheter heart valve presented with acute heart failure. Computed tomography demonstrated severe prosthetic stenosis and a high risk of left coronary obstruction (virtual valve-to-coronary distance 3.4 mm). Redo TAVR was performed using intravascular ultrasound (IVUS)-guided UNICORN (Undermining Iatrogenic Coronary Obstruction with Radiofrequency Needle) leaflet modification, followed by implantation of a 23-mm RESILIA valve. IVUS enabled precise leaflet traversal and real-time assessment of the relationship between the modified leaflet, valve frame, and left main coronary artery, resulting in an excellent procedural and hemodynamic outcome. CONCLUSIONS: This is the first reported IVUS-guided UNICORN leaflet modification during TAVR-in-TAVR, highlighting its potential to improve procedural precision and safety in patients at high risk of coronary obstruction.
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Hailan et al. (2026) conducted a case report in Severe prosthetic stenosis and high risk of left coronary obstruction (n=1). IVUS-guided UNICORN leaflet modification was evaluated on Procedural and hemodynamic outcome. IVUS-guided UNICORN leaflet modification during TAVR-in-TAVR resulted in an excellent procedural and hemodynamic outcome in a patient at high risk of coronary obstruction.
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