Percutaneous Transapical Bioprosthetic Leaflet Modification Facilitated Transfemoral Valve-in-Surgical Bioprosthetic Transcatheter Aortic Valve Replacement: Undermining Iatrogenic Coronary Obstruction With Radiofrequency Needle (UNICORN).

An 81-year-old male presented with severe, symptomatic bioprosthetic surgical aortic valve dysfunction. He was considered high-risk for reoperation and cardiovascular imaging determined him to be a very high-risk for coronary occlusion with valve-in-valve TAVR. This is the first reported case of valve-in-valve TAVR facilitated by percutaneous transapical UNICORN procedure.