Transcatheter Valve Implantation in Degenerated Bioprosthetic Surgical Valves (ViV) in Aortic, Mitral, and Tricuspid Positions: A Review

Bioprosthetic surgical heart valves (SHVs) tend to degenerate with time, and valve re-operation carries substantial risks. Transcatheter heart valve (THV) implantation into a degenerative biological bioprosthesis (valve-in-valve [ViV] procedure) has evolved as a viable strategy in suitable cases of SHV degeneration, and nearly all heart valves have already been treated using the ViV technique. The creation of an optimal effective orifice area and a sufficient, yet atraumatic, expansion and sealing of the neo-valve (in-valve) apparatus is key for optimal ViV implantation. Several aspects are necessary to achieve this, including a detailed appreciation of the SHV and THV, pre-procedural learning of the anatomy, optimal access selection, and avoidance of any interference with the perivalvular structures. This review based on the authors' personal experience and an updated review of the literature is aimed at covering contemporary accumulated knowledge of ViV therapeutics in the aortic, mitral, and tricuspid positions, focusing on practical issues and challenges for optimal patient outcomes.