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Page 12 of 16 Annibali et al. Mini-invasive Surg 2022;6:12 https://dx.doi.org/10.20517/2574-1225.2021.101

be individualized based on operative risk factors (e.g., expected increase in catheter manipulation, multiple
[12]
repositioning maneuvers, pre- and post-dilatation/BVF, and BASILICA procedure) .
CONCLUSION
ViV TAVR is a safe, effective and well-established procedure supported by increasingly convincing data.
The procedure is a viable alternative treatment option for failed surgical bioprosthetic valves, currently
approved for patients judged to be at prohibitive risk for surgical redo. It is a complex procedure that can
present many pitfalls and therefore must be performed in high volume centers and with experienced
personnel because the risk of peri- and post-procedural complications is much higher than TAVR on native
valve. Techniques such as BASILICA or surgical prosthesis fracture have reduced the rate of postprocedural
complications such as elevated postprocedural gradients, coronary obstruction and leaflet thrombosis while
improving the safety and long-term outcomes of the procedure. Because of the opening of TAVR to
younger and younger patients, thus with a longer life expectancy than the durability of the bioprosthesis, the
next challenge will be the management of the lifetime strategy of patients with aortic stenosis, as the first
type of intervention will influence all future therapeutic choices of our patient.

DECLARATIONS
Authors’ contributions
Performed data analysis, interpretation and manuscript write up: Annibali G
Technical description of operative steps, data acquisition: Annibali G
Review of manuscript: Annibali G, Scrocca I
Review and substantial contributions to conception and design of study: Annibali G, Musumeci G

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2022.

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