UNICORN TAVR in Native Complex Congenital Aortic Stenosis at High Risk of Coronary Obstruction

Coronary artery obstruction is a rare but serious complication of transcatheter aortic valve replacement (TAVR). Undermining iatrogenic coronary obstruction with a radiofrequency needle (UNICORN) is a novel technique of intraleaflet TAVR valve deployment for mitigating this risk. There is limited experience in native aortic valve anatomy, particularly in congenital aortic stenosis.

A 26-year-old man in cardiogenic shock secondary to severe congenital aortic stenosis was successfully treated with emergency TAVR, with leaflet modification using the UNICORN technique due to the high risk of coronary obstruction.

UNICORN is a novel technique for preventing coronary obstruction in TAVR. Here we describe the first case of UNICORN in congenital aortic stenosis in cardiogenic shock at prohibitive surgical risk.

UNICORN can be used successfully in carefully selected native valves at risk of coronary obstruction during TAVR. Use of leaflet modification techniques such as UNICORN enables intervention in a broader cohort of patients unfit for surgery.