Perspective Chapter: Valve-in-Valve Transcatheter Aortic Valve Replacement (ViV) for Failed Bioprosthetic Valves

Abstract

Aortic valve disease remains the second most common valvular heart disease worldwide. Surgical aortic valve replacement (SAVR) with mechanical or bioprosthetic valves and transcatheter aortic valve replacement (TAVR) with bioprosthetic valves are both approved therapies for patients with severe aortic stenosis (AS) across all surgical risk categories. On the other hand, SAVR remains the mainstay of treatment for severe aortic regurgitation (AR) with TAVR reserved for selected patients at prohibitive surgical risk. Both surgical and transcatheter bioprosthetic valves are prone to bioprosthetic valve failure (BVF) due to various etiologies, and can lead to restenosis, regurgitation, or a combination of both. BVF can now be addressed by repeat valve replacement whether surgical or valve-in-valve TAVR (ViV). ViV is a desirable option for elderly patients at high surgical risk and requires meticulous planning with pre-operative CT imaging to optimize outcomes and minimize complications.