Transcatheter valve-in-valve implantation for degenerated surgical bioprostheses.

Transcatheter valve-in-valve (VIV) procedures are less invasive than re-do open heart surgery, and have proven relatively safe and effective. In large multicentre registries morbidity and mortality risks are generally lower than with surgery, and improvement in quality of life can be profound. Outcomes continue to improve with advances in transcatheter heart valve (THV) technology, techniques, and expertise. However specific concerns remain; including residual stenosis, coronary obstruction, left ventricular outflow tract obstruction, and thrombosis. The unknown durability is a concern in patients with the potential for longevity. Transcatheter VIV procedures will likely increasingly be favoured over reoperation when bioprosthetic heart valves fail, particularly when surgical risks are high.