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Valve-in-Valve Transcatheter Aortic Valve Replacement: A Review of Procedural Details, Safety, and Clinical Implications

Bioprosthetic valves are increasingly being used to treat young patients needing surgical intervention. The rising number of young patients undergoing bioprosthesis implantation also means that many of these patients will ultimately require reintervention due to the deteriorative nature of these valves. Recently, valve-in-valve transcatheter aortic valve replacement (ViV TAVR) has become the preferred procedure to treat high-risk patients requiring repeat surgical aortic valve replacement. Despite being less invasive, ViV TAVR is accompanied by risks, including coronary obstruction, valvular thrombosis, and postoperative residual gradients. Furthermore, there are limited long-term data on ViV TAVR detailing prognosis, and operators often rely on anecdotal experience and personal judgment for clinical decision-making. In this article, we review the procedural details, safety, and clinical implications of ViV TAVR.