Leaflet Modification Technique With UNICORN in Failed Aortic Bioprosthesis: Procedural Step-by-Step, Best Practice, and Troubleshooting.
KE, C., KC, U., HAC, C., D, T.L.C., SY, S., WH, Y., YT, L., YT, L., P, L., & M, A.W. (2026). Leaflet Modification Technique With UNICORN in Failed Aortic Bioprosthesis: Procedural Step-by-Step, Best Practice, and Troubleshooting.. JACC. Cardiovascular interventions. https://doi.org/10.1016/j.jcin.2026.04.031
KE C, KC U, HAC C, D TLC, SY S, WH Y, et al. Leaflet Modification Technique With UNICORN in Failed Aortic Bioprosthesis: Procedural Step-by-Step, Best Practice, and Troubleshooting.. JACC. Cardiovascular interventions. 2026; doi: 10.1016/j.jcin.2026.04.031
KE C, KC U, HAC C, et al. Leaflet Modification Technique With UNICORN in Failed Aortic Bioprosthesis: Procedural Step-by-Step, Best Practice, and Troubleshooting.[J]. JACC. Cardiovascular interventions. 2026. DOI: 10.1016/j.jcin.2026.04.031.
@article{ke2026,
author = {Chan KE and Un KC and Chiu HAC and Tai-Leung Chan D and Sze SY and Yin WH and Lee YT and Lee YT and Lin P and Abdel-Wahab M},
title = {Leaflet Modification Technique With UNICORN in Failed Aortic Bioprosthesis: Procedural Step-by-Step, Best Practice, and Troubleshooting.},
journal = {JACC. Cardiovascular interventions},
year = {2026},
doi = {10.1016/j.jcin.2026.04.031},
note = {PMID: 42331405},
}
TY - JOUR AU - Chan KE AU - Un KC AU - Chiu HAC AU - Tai-Leung Chan D AU - Sze SY AU - Yin WH AU - Lee YT AU - Lee YT AU - Lin P AU - Abdel-Wahab M TI - Leaflet Modification Technique With UNICORN in Failed Aortic Bioprosthesis: Procedural Step-by-Step, Best Practice, and Troubleshooting. T2 - JACC. Cardiovascular interventions PY - 2026 DO - 10.1016/j.jcin.2026.04.031 AN - PMID:42331405 ER -
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.