Leaflet Modification Technique With UNICORN in Failed Aortic Bioprosthesis

Kwong Yue Eric Chan; Ka Chun Un; Ho On Alston Conrad Chiu; Daniel Tai-Leung Chan; Shu Yue Sze; Wei Hsian Yin; Yung Tsai Lee; Yee Tat Lee; Pei Lin; Mohamed Abdel-Wahab; Andrei M. Pop; Didier Tchetche; Phillip Freeman; Ole De Backer; Karl Poon; Mann Chandavimol; Gilbert H.L. Tang; Chun Ka Wong; Simon Cheung Chi Lam

doi:10.1016/j.jcin.2026.04.031

Leaflet Modification Technique With UNICORN in Failed Aortic Bioprosthesis

Kwong Yue Eric Chan
, Ka Chun Un
, Ho On Alston Conrad Chiu
, Daniel Tai-Leung Chan
, Shu Yue Sze
, Wei Hsian Yin
, Yung Tsai Lee
, Yee Tat Lee
, Pei Lin
, Mohamed Abdel-Wahab
, Andrei M. Pop
, Didier Tchetche
, Phillip Freeman
, Ole De Backer
, Karl Poon
, Mann Chandavimol
, Gilbert H.L. Tang
, Chun Ka Wong
, Simon Cheung Chi Lam

Department of Medicine

The University of Hong Kong Li Ka Shing Faculty of Medicine
Queen Mary Hospital Hong Kong
Grantham Hospital Hong Kong
Cheng Hsin General Hospital
National Yang Ming University Hospital
China Medical University
Leipzig Heart Center
Alexian Brothers Medical Center
Clinique Pasteur
Karolinska Institutet and Karolinska University Hospital
Rigshospitalet
University of Queensland
Prince Charles Hosp
Mount Sinai Health System and Icahn School of Medicine at Mount Sinai

Research output: Contribution to journal › Review article › peer-review

1 Citation (Scopus)

Abstract

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.

Original language	English
Pages (from-to)	1565-1578
Number of pages	14
Journal	JACC: Cardiovascular Interventions
Volume	19
Issue number	12
DOIs	https://doi.org/10.1016/j.jcin.2026.04.031
Publication status	Published - 22 Jun 2026

Keywords

UNICORN
leaflet modification
transcatheter aortic valve replacement
transcatheter electrosurgery

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10.1016/j.jcin.2026.04.031

Cite this

Chan, K. Y. E., Un, K. C., Chiu, H. O. A. C., Tai-Leung Chan, D., Sze, S. Y., Yin, W. H., Lee, Y. T., Lee, Y. T., Lin, P., Abdel-Wahab, M., Pop, A. M., Tchetche, D., Freeman, P., De Backer, O., Poon, K., Chandavimol, M., Tang, G. H. L., Wong, C. K., & Lam, S. C. C. (2026). Leaflet Modification Technique With UNICORN in Failed Aortic Bioprosthesis. JACC: Cardiovascular Interventions, 19(12), 1565-1578. https://doi.org/10.1016/j.jcin.2026.04.031

@article{86355797027e40ef805786ffdb8bf6c5,

title = "Leaflet Modification Technique With UNICORN in Failed Aortic Bioprosthesis",

abstract = "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.",

keywords = "UNICORN, leaflet modification, transcatheter aortic valve replacement, transcatheter electrosurgery",

author = "Chan, \{Kwong Yue Eric\} and Un, \{Ka Chun\} and Chiu, \{Ho On Alston Conrad\} and \{Tai-Leung Chan\}, Daniel and Sze, \{Shu Yue\} and Yin, \{Wei Hsian\} and Lee, \{Yung Tsai\} and Lee, \{Yee Tat\} and Pei Lin and Mohamed Abdel-Wahab and Pop, \{Andrei M.\} and Didier Tchetche and Phillip Freeman and \{De Backer\}, Ole and Karl Poon and Mann Chandavimol and Tang, \{Gilbert H.L.\} and Wong, \{Chun Ka\} and Lam, \{Simon Cheung Chi\}",

note = "Publisher Copyright: {\textcopyright} 2026 American College of Cardiology Foundation.",

year = "2026",

month = jun,

day = "22",

doi = "10.1016/j.jcin.2026.04.031",

language = "English",

volume = "19",

pages = "1565--1578",

journal = "JACC: Cardiovascular Interventions",

issn = "1936-8798",

publisher = "Elsevier Inc.",

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Chan, KYE, Un, KC, Chiu, HOAC, Tai-Leung Chan, D, Sze, SY, Yin, WH, Lee, YT, Lee, YT, Lin, P, Abdel-Wahab, M, Pop, AM, Tchetche, D, Freeman, P, De Backer, O, Poon, K, Chandavimol, M, Tang, GHL, Wong, CK & Lam, SCC 2026, 'Leaflet Modification Technique With UNICORN in Failed Aortic Bioprosthesis', JACC: Cardiovascular Interventions, vol. 19, no. 12, pp. 1565-1578. https://doi.org/10.1016/j.jcin.2026.04.031

TY - JOUR

T1 - Leaflet Modification Technique With UNICORN in Failed Aortic Bioprosthesis

AU - Chan, Kwong Yue Eric

AU - Un, Ka Chun

AU - Chiu, Ho On Alston Conrad

AU - Tai-Leung Chan, Daniel

AU - Sze, Shu Yue

AU - Yin, Wei Hsian

AU - Lee, Yung Tsai

AU - Lee, Yee Tat

AU - Lin, Pei

AU - Abdel-Wahab, Mohamed

AU - Pop, Andrei M.

AU - Tchetche, Didier

AU - Freeman, Phillip

AU - De Backer, Ole

AU - Poon, Karl

AU - Chandavimol, Mann

AU - Tang, Gilbert H.L.

AU - Wong, Chun Ka

AU - Lam, Simon Cheung Chi

PY - 2026/6/22

Y1 - 2026/6/22

N2 - 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.

AB - 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.

KW - UNICORN

KW - leaflet modification

KW - transcatheter aortic valve replacement

KW - transcatheter electrosurgery

UR - https://www.scopus.com/pages/publications/105041625957

U2 - 10.1016/j.jcin.2026.04.031

DO - 10.1016/j.jcin.2026.04.031

M3 - Review article

AN - SCOPUS:105041625957

SN - 1936-8798

VL - 19

SP - 1565

EP - 1578

JO - JACC: Cardiovascular Interventions

JF - JACC: Cardiovascular Interventions

IS - 12

ER -

Leaflet Modification Technique With UNICORN in Failed Aortic Bioprosthesis

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