First-in-Human Mechanical Bilateral Iatrogenic Coronary Leaflet Obstruction Risk Nullification (BICORN) for Transcatheter Aortic Valve-in-Valve Replacement.

Authors

Hussam Al Hennawi, Vernon Mascarenhas, Abdellaziz Dahou, Ahmad Sameed Akram, Tariq Ahmad

Published in

JACC. Case reports. Pages 111098. Nov 06, 2026. Epub Nov 06, 2026.

Abstract

We describe mechanical leaflet traversal as an alternative to electrosurgical traversal for BICORN during valve-in-valve transcatheter aortic valve replacement in a patient with unfavorable cardiac orientation and extreme bilateral coronary obstruction risk.
The ShortCut device created targeted basal splits in both coronary leaflets. The left coronary cusp split was crossed using a Pilot 100 guidewire (Abbott) and microcatheter with an EBU 3.5 guide catheter (Medtronic) and Agilis steerable introducer (Abbott) support. After balloon dilation, the left coronary cusp was translocated with an 18-mm True Dilatation Balloon (BD). A 20-mm SAPIEN 3 Ultra transcatheter heart valve (Edwards Lifesciences) was then advanced through the right coronary cusp split and deployed within the pre-existing 23-mm SAPIEN 3 valve (Edwards Lifesciences).
Mechanical traversal requires precise targeting. Leaflet translocation may cause embolization, severe aortic insufficiency, or hemodynamic compromise, requiring readiness for immediate valve deployment.
Mechanical traversal may facilitate BICORN when cardiac rotation, unfavorable catheter trajectory, neosinus malalignment, eccentric coronary takeoffs, or leaflet fibrocalcification make electrosurgical traversal challenging.

PMID:
42993127
Bibliographic data and abstract were imported from PubMed on 06 Nov 2026.

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