Challenges in Valve-in-Valve Therapy for Aortic Valves

Transcatheter aortic valve replacement has recently established itself as the treatment of choice in inoperable and high-risk patients with aortic stenosis. Experience in this field has led to its usage for novel indications such as its use in the treatment of a degenerative biological surgical heart valves and is referred to as valve-in-valve (VIV). Early experience demonstrates that the procedure is not without risks. High residual gradients, coronary occlusion, embolization, and thrombosis have been reported. We aim to discuss relevant features of the different surgical and transcatheter devices and discuss the optimal strategy to avoid these complications after a VIV procedure.