Transesophageal Echocardiogram to Guide Valve-in-Valve Transcatheter Aortic Valve Replacement of a Failed Medtronic-Freestyle Aortic Prosthesis.

Valve-in-valve transcatheter aortic valve replacement (ViV TAVR) is an appealing alternative to surgical intervention on failed aortic prosthesis with comparable safety and efficacy. ViV TAVR has proven to be a technical challenge in stentless bioprosthetic aortic valves like free style aortic valve prosthesis. In this case series of two patients we report the utility of transesophageal echocardiogram guidance to help visualize surgical annulus and TAVR deployment.