Double LLAMACORN: Bilateral Leaflet Modification Technique to Prevent Coronary Obstruction
Andrea Ruberti1, Laura Sanchis2, Omar Abdul-Jawad Altisent2
1Hospital Clínic, Cardiovascular Clinic Institute, Barcelona, Catalunya, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalunya, Spain; Facultat de Medicina i Ciencies de la Salut, Universitat de Barcelona (UB), Barcelona, Spain; Bellvitge Universitary Hospital, Barcelona, Catalunya, Spain.
Objective:
To describe the double LLAMACORN (Leaflet Laceration with Balloon-Mediated Annihilation to prevent coronary obstruction with radiofrequency needle) procedure as a strategy for bilateral leaflet modification before valve-in-valve transcatheter aortic valve replacement (TAVR) in a patient at high risk for coronary obstruction.
Key Steps:
The right and left leaflets were traversed using electrosurgery. Sequential bileaflet dilatation was performed using coronary balloons and positioning of 2 extra-stiff Safari wires through the leaflets. Sequential bileaflet laceration was achieved with Atlas balloons. A 23-mm Navitor was deployed, with postdilatation as needed.
Potential Pitfalls:
Catheter entanglement may occur, particularly in small anatomies. Hemodynamic compromise may result from aortic regurgitation after simultaneous leaflet laceration.
Take-Home Message:
Double LLAMACORN is a feasible alternative to BASILICA (bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction), streamlining bilateral leaflet modification and preserving coronary flow.
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