ArticleJACC. Asia2026
UNICORN for Valve-in-Valve Transcatheter Aortic Valve Replacement: UNICORN Hong Kong Registry.
Article in JACC. Asia, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- Redo TAVR With Fluoroscopic-Free Surgical Resection of Prosthetic Valve Leaflets Under Direct Vision (SURPLUS) Technique.JACC. Asia · 2026Article
- In vitro comparison of classic BASILICA, balloon-assisted BASILICA and UNICORN during transcatheter aortic valve replacement.Cardiovascular intervention and therapeutics · 2026Article
- Evolving Landscapes in Mitigating Coronary Obstruction for Transcatheter Aortic Valve Replacement (TAVR).JACC. Case reports · 2026Article
- The Chordal-Zone Free Externalization of Retrograde Wire (CLEAR) Procedure to Facilitate BASILICA and Transcatheter Electrosurgical Procedures.JACC. Case reports · 2026Article
- Multicenter Experience of Aortic Valve Leaflet Modification in TAVR: From the Asia-Pacific Electrosurgery Working Group.JACC. Asia · 2026Article
- Variations and Evolution in Balloon-Based Leaflet Modification: Ensuring Procedural Success.JACC. Case reports · 2026Article
- UNICORN During Transcatheter Aortic Valve Replacement in Native and Bioprosthetic Aortic Valves: A Multicenter Study.JACC. Cardiovascular interventions · 2026Article
- Current Evidence, Emerging Evidence, and Decision-Making: An Algorithm for Leaflet Modification Procedures.JACC. Cardiovascular interventions · 2026Review
- Aortic Valve Leaflet Modification: A Working Group Position Statement on Best Practices and Step-by-Step Guide.JACC. Cardiovascular interventions · 2026Review
- Article
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Authors and funding
20 authors.
Funding
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Abstract
backgroundUndermining Iatrogenic Coronary Obstruction With Radiofrequency Needle (UNICORN) was developed to mitigate coronary obstruction risk during valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) with balloon-expandable valves (BEVs). A modified UNICORN with recrossing technique was subsequently described for self-expanding valves (SEVs).
objectivesThis study aimed to assess early outcomes of the UNICORN technique.
methodsThe UNICORN Hong Kong Registry was a single-center, retrospective observational study at Queen Mary Hospital, Hong Kong, including consecutive patients undergoing ViV-TAVR between July 2024 and August 2025. Patients were treated with either UNICORN using BEV or UNICORN with recrossing using SEV. The primary endpoint was procedural success, defined as successful leaflet traversal, intended leaflet laceration, and transcatheter heart valve implantation without procedural mortality, coronary obstruction, or emergency surgery. Secondary outcomes included 30-day safety events per Valve Academic Research Consortium-3.
resultsSeventeen patients (41.2% male; 78.3 ± 6.61 years) underwent ViV-TAVR: 8 with BEV and 9 with SEV using the recrossing technique. All SEV patients had prior surgical valves, whereas in the BEV group 50.0% had surgical valves and 50.0% had transcatheter valves. Coronary ostium at risk was left in 58.8%, right in 29.4%, and bilateral in 11.8%. Median coronary height was 7.80 [7.00-8.50] mm and mean virtual transcatheter heart valve to coronary distance was 4.56 ± 1.48 mm. One patient required bileaflet modification with concomitant UNICORN and Bioprosthetic or Native Aortic Scallop Intentional Laceration to Prevent Iatrogenic Coronary Artery Obstruction. Procedural success was achieved in all patients with no coronary obstruction. At 30 days, 1 patient (5.88%) required pacemaker implantation.
conclusionsThe UNICORN technique was feasible for preventing coronary obstruction during ViV-TAVR and warrants further evaluation in larger trials.
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