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Valve-in-Valve TAVI — EECC MCQ

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ModerateValvular Heart DiseaseValve-in-Valve TAVIEECC

A 78-year-old man had a surgical bioprosthetic AVR 12 years ago. He now presents with progressive breathlessness. Echocardiography shows structural valve degeneration with severe AS (mean gradient 42 mmHg, AVA 0.7 cm²). He is high surgical risk (STS score 8%). What intervention should be considered?

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Correct answer: B — Valve-in-valve TAVI implanted within the degenerated bioprosthesis

Valve-in-valve (ViV) TAVI is now an established treatment for failed surgical bioprosthetic valves (structural valve degeneration with significant stenosis and/or regurgitation) in patients at intermediate-to-high surgical risk. The 2025 ESC/EACTS VHD Guidelines recommend ViV TAVI as an alternative to redo surgery in these patients (Class IIa). Key considerations include: accurate sizing based on the internal diameter of the degenerated valve (risk of patient-prosthesis mismatch is higher in small surgical valves), coronary obstruction risk (particularly with externally mounted leaflets), and need for CT planning. ViV TAVI has lower procedural mortality than redo surgery in high-risk patients.

Reference: ESC/EACTS (2025): Guidelines for the Management of Valvular Heart Disease