Advancing TAVR Safety: UNICORN and High-Risk Aortic Valve Intervention at Atlantic Health Morristown Medical Center

November 3, 2026
Gennaro Giustino, MD

 

 

Transcatheter aortic valve replacement has become standard therapy for severe aortic stenosis across a broad range of patients. As experience has grown, attention has shifted toward identifying anatomical features that increase procedural risk, including the potential for coronary artery obstruction. 

At Atlantic Health Morristown Medical Center, advanced leaflet modification strategies are used selectively in patients whose anatomy raises concern. 

Gennaro Giustino, MD, structural interventional cardiologist at Atlantic Health, describes the UNICORN technique as one such strategy. 

“The UNICORN technique is a leaflet modification technique designed to prevent coronary artery obstruction during transcatheter aortic valve replacement,” Dr. Giustino says. 

An Evolution of BASILICA 

He explains that UNICORN evolved from BASILICA, “the transcatheter electrosurgical laceration of one of the leaflets of the aortic valve in order to prevent obstruction.” 

“UNICORN evolved so that the laceration of the leaflet is performed with a larger balloon instead of electrifying wires,” he notes. 

The goal remains preventive — modifying the leaflet before valve deployment to reduce obstruction risk in carefully selected patients. 

“In my opinion, UNICORN tends to be more effective in patients that are extreme risk for occlusion of the coronary artery,” Dr. Giustino says. 

Institutional Experience 

Since joining Atlantic Health, Dr. Giustino has performed more than 20 UNICORN procedures. 

“We have published our series with excellent outcomes,” he explains, noting that some cases involved “extreme-risk patients who probably would not have had any other option.” 

Leaflet modification procedures account for approximately 4 to 5 percent of structural heart cases at Atlantic Health Morristown, representing 30 to 40 procedures annually. 

Why Volume Supports Safety 

Atlantic Health Morristown performs more than 1,000 structural heart cases annually. 

High-volume programs develop coordinated workflows for imaging review, heart team discussion, anesthesia planning, and mechanical support readiness. For patients with anatomical complexity, these institutional capabilities support procedural planning that anticipates risk. 

Referral Considerations 

Early structural consultation may be appropriate for patients with severe aortic stenosis and anatomical features that raise concern for coronary obstruction, prior bioprosthetic valves, or complex anatomy. 

Evaluation allows discussion of standard TAVR planning versus preventive leaflet modification strategies when appropriate.