Valve-In-Valve Transcatheter Aortic Valve Replacement: Advances in Planning, Technique, and Lifetime Management.

Valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) has emerged as a key reintervention strategy for failed surgical bioprostheses. Meticulous preprocedural planning with computed tomography, fluoroscopy, and transesophageal echocardiography is essential for optimal outcomes. Emerging artificial intelligence-based technologies may help mitigate associated risks such as coronary obstruction and patient-prosthesis mismatch and assist with lifetime management planning for valvular heart disease. Transcatheter valve underexpansion can be addressed through bioprosthetic valve fracture in select cases. ViV-TAVR is likely to continue to grow in prevalence given an aging population, its minimally invasive nature compared to redo surgical aortic valve replacement, and its favorable safety profile.