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Advancing TAVR Safety: UNICORN and High-Risk Aortic Valve Intervention at Atlantic Health Morristown Medical Center
November 3, 2026 | Gennaro Giustino, MD, structural interventional cardiologist at Atlantic Health, describes the UNICORN technique as a strategy used selectively in patients whose anatomy raises concern.
The article describes UNICORN, a leaflet modification technique used selectively to help prevent coronary artery obstruction during TAVR, and summarizes Atlantic Health Morristown’s experience with the procedure.
Approach:
Technique: UNICORN modifies an aortic valve leaflet before valve deployment. Dr. Giustino says it evolved from BASILICA and uses a larger balloon to perform the leaflet laceration instead of electrified wires.
Patient selection: Dr. Giustino describes using leaflet modification selectively when anatomy raises concern, particularly in patients at extreme risk of coronary artery occlusion.
Program experience: Dr. Giustino reports performing more than 20 UNICORN procedures since joining Atlantic Health. Leaflet modification procedures account for approximately 4–5% of structural heart cases at Atlantic Health Morristown, or 30–40 procedures annually.
Key Findings:
Dr. Giustino describes UNICORN as a leaflet modification technique designed to prevent coronary artery obstruction during TAVR.
Dr. Giustino reports that Atlantic Health has published its UNICORN series with “excellent outcomes”; the article does not provide quantitative outcome data.
Atlantic Health Morristown performs more than 1,000 structural heart cases annually.
Interpretation:
The article presents UNICORN as a preventive leaflet modification technique used selectively for patients whose anatomy raises concern for coronary artery obstruction, with Dr. Giustino describing it as particularly suited to patients at extreme risk.
Limitations:
The article does not provide methods, patient characteristics, or quantitative outcome data for the published UNICORN series.
The account of UNICORN experience is based on statements from Dr. Giustino and describes Atlantic Health’s institutional experience.
Conclusion:
The article describes Atlantic Health Morristown’s selective use of leaflet modification and notes that structural heart evaluation can include discussion of standard TAVR planning and preventive leaflet modification when anatomy raises concern.
