Work

BICORN (Bilateral Iatrogenic Coronary Obstruction Risk Nullification) Procedure for Transcatheter Aortic Valve-in-Valve Replacement

Year: 2025

Type: article

Abstract: OBJECTIVES: We describe a bilateral coronary leaflet modification technique that involves translocation of degenerated transcatheter valve leaflets before placement of valve-in-valve, named Bilateral Iatrogenic Coronary Obstruction Risk Nullification (BICORN). KEY STEPS: Key steps include the following: 1) Electrified 0.014-in ASTATO wires were traversed through the base of the right and left coronary leaflets of preexisting CoreValve, which were then swapped with 0.035-in wires; 2) Using peripheral balloons, leaflet traversal points were appropriately dilated; 3) A 26-mm Sapien valve was then advanced over the wire through the left coronary leaflet to the ascending aorta in a deployment-ready state; and 4) Right coronary leaflet was then translocated with 18-mm True balloon followed by deployment of the Sapien valve lined up to sixth node of the CoreValve. POTENTIAL PITFALLS: Translocation of preexisting valve leaflets is an uncontrolled step and can potentially lead to distal embolization and or severe aortic valve insufficiency. TAKE-HOME MESSAGES: BICORN can be considered as an option for transcatheter aortic valve in transcatheter aortic valve replacement in patients with extreme surgical risk.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2025.105145

Authors: Tariq Ahmad, Vernon Mascarenhas, Terry Bauch, Tyler Wallen, Russell Allan Carter

Institution: Geisinger Health System

Language: English

Topic: Cardiac Valve Diseases and Treatments

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $850