THV-in-THV for failed self expandable prothesis in 53 y.o. patient

Leaflet modification with BASILICA (bioprosthetic aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction), even when balloon-assisted, may not effectively prevent coronary obstruction for all high-risk redo transcatheter aortic valve replacement (TAVR) procedures. Insufficient leaflet splay after BASILICA may be caused by the metallic stent frame preventing excursion of the lacerated leaflet or underexpansion of the valve frame, resulting in crowded leaflets. Therefore, alternative techniques such as UNICORN (undermining iatrogenic coronary obstruction with a radiofrequency needle) may be useful in certain situations. In these videos, we will guide the viewer with a step-by-step approach through the pre-procedural planning and intra-procedural aspects of redo-TAVR with UNICORN with a self-expanding valve to treat a degenerated balloon-expandable valve.