Transcatheter valve-in-valve implantation for degenerated aortic bioprostheses: Still not ready for prime-time

The progressively increasing experience with transcatheter aortic valve implantation (TAVI) together with the publication of new prospective randomized studies showing the non-inferiority and sometimes the superiority of this technique when compared to surgical aortic valve replacement (SAVR) also in low risk patients [1,2] has led to the expansion of the indications for TAVI. Consequently, there has also been a growing interest towards transcatheter bioprostheses implantation in the setting of structural deterioration of previously implanted aortic xenografts in order to avoid surgical reintervention. Valve-in-valve (ViV) procedure represents a micro-invasive approach [3] for patients with degenerated aortic bioprostheses since it enables to implant a new valve inside the malfunctioning one, on the beating heart, with no need for cardiopulmonary bypass, with no skin incision and with local anesthesia if performed through a transfemoral access. All these aspects make ViV particularly interesting as an alternative therapeutic option in patients with failing bioprostheses. In this issue of the IJC, Dr. Woitek and his colleagues from Leipzig, evaluate their results with conventional redo surgery (Re-SAVR) and with valve-invalve transfemoral TAVI (VinV-TFAVI) in 258 consecutive patients [4]. As authors have correctly pointed out, this study should not be considered a true comparison of these techniques since baseline characteristics are different in the two cohorts, but rather a “hypothesis