Aortic valve-in-valve TAVR

Transcatheter aortic valve-in-valve (VIV) is established treatment of degenerative surgical bioprostheses in patients at high operative risk and was approved by the US Food and Drug Administration in 2015. The AHA/ACC guidelines for the management of patients with valvular heart disease give it class IIa indication based on nonrandomized data including registries and case series only. When planning an aortic VIV procedure, therapy of small surgical valves should be approached with caution, as patient prosthesis mismatch (PPM) and significant residual gradients remain a major challenge. In addition, when the indication for the procedure is valve regurgitation, every effort should be taken to rule out aortic para-valvular leak, since VIV implantation is not expected to improve hemodynamics in this case. In addition to careful patient selection and procedural planning, the VIV procedure itself has particular operator-associated aspects that will be discussed in this chapter. Despite growing experience with this procedure, for selected patients, such as very-low-risk patients and patients with small diameter bioprosthesis, a heart team discussion should still consider the option of redo surgical aortic valve replacement.