Prevention of Bilateral Coronary Obstruction During Valve-In-Valve TAVR With a Self-Expanding Valve: The BABICORN Procedure.

OBJECTIVE

We present a case of valve-in-valve transcatheter aortic valve replacement in an 85-year-old woman with severe bioprosthetic aortic valve stenosis at a high risk of left and right coronary artery obstruction. This risk was mitigated by a procedure combining both BASILICA and UNICORN (BABICORN [Bileaflet Alteration with BASILICA and Iatrogenic Cusp Obliteration Using Radiofrequency Needle]) for double leaflet modification.

KEY STEPS

Electrosurgical traversal of the right leaflet and creating the electrosurgical loop using 2 guide catheters and an Astato wire within. Electrosurgical traversal of the left leaflet and ballooning the leaflet fenestration. Creating the flying V and lacerating the right leaflet. Serial ballooning and ultimately lacerating the left leaflet. Deployment of the Evolut valve.

POTENTIAL PITFALLS

Catheter entanglement, inadequate leaflet laceration, and stroke or systemic embolization.

TAKE-HOME MESSAGE: The BABICORN procedure for double leaflet modification before valve-in-valve transcatheter aortic valve replacement with a self-expanding valve is technically feasible and preserves coronary flow in both native arteries.