Related Experiment Video
Updated: Oct 17, 2026

Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Valve-in-Root TAVI vs Redo Surgery in a Young Adult With Failed Bioprosthesis
Rushmi Purmessur1, Luigia D'Errico2, Charis Costopoulos3
1Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, United Kingdom.
Topic Of Controversy:
Whether valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) or redo surgical aortic valve replacement (SAVR) is preferred for structural valve degeneration of a Freestyle stentless aortic root in a young adult, and whether a Ross procedure at index surgery would have better served lifetime management.
Case Summary:
A 30-year-old man with a failed stentless aortic root (implanted at age 20 for bicuspid aortic valve regurgitation) presented with severe bioprosthetic regurgitation and ventricular dilatation. Transfemoral ViV TAVI with a 29-mm Edwards SAPIEN 3 Ultra Resilia was performed successfully.
Pro Viewpoint:
ViV TAVI avoids redo sternotomy, preserves future options, and aligns with patient preference to avoid anticoagulation.
Con Viewpoint:
Redo SAVR with a mechanical valve-and a Ross procedure at the index operation-may offer superior lifetime sequencing, avoiding constraints of successive transcatheter implants.
Take-Home Message:
Lifetime planning must begin at the index operation; both ViV TAVI and redo SAVR require heart team deliberation with explicit consideration of all future interventions.
More Related Videos
Related Concept Videos
Mitral Stenosis III: Medical Management
Aortic Regurgitation III: Medical Management
Mitral Regurgitation III: Medical Management
Mitral Valve Prolapse II: Assessment and Management
Mitral Valve Prolapse I: Introduction
Mitral Valve Prolapse III: Nursing Management

