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

ABSTRACT 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.