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Updated: Jan 13, 2026

Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Valve-in-Valve Transcatheter Aortic Valve Implantation Versus Redo SAVR for Degenerated Biological Prosthesis: A
Salvatore Torre1, Laura Asta2, Adriana Sbrigata1
1Cardiac Surgery Unit, Department of Precision Medicine in Medical Surgical and Critical Area (Me.Pre.C.C.), University of Palermo, 90134 Palermo, Italy.
Abstract:
Surgical aortic valve replacement (SAVR) is still the gold-standard treatment for aortic stenosis. However, the increasing use of biological prostheses, even in young patients, makes Valve-in-Valve (ViV) transcatheter aortic valve implantation (TAVI) an attractive option compared to redo SAVR, thanks to its lower invasiveness and sometimes greater safety. However, there are several technical and anatomical aspects to consider. Therefore, the aim of our review is to examine the main mechanisms responsible for the degeneration of biological prostheses and, subsequently, to analyze the hemodynamic (transvalvular gradients, patient-prosthesis mismatch, paravalvular leakage) and technical (risk of coronary obstruction, prosthetic implantation strategy) aspects that most influence the procedure's success and long-term outcomes. To this end, we present a case we treated in order to enhance our readers' experience with this procedure. Currently, ViV TAVI is approved for patients at high surgical risk, but it could become a valid option compared to redo SAVR; however, more clinical trials are needed to better analyze the survival differences between these two procedures. Furthermore, it remains a therapeutic strategy reserved for highly specialized centers due to the technical difficulties involved in its execution.
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