The first recommended treatment in the treatment of degenerated bioprosthetic valves is reoperation; however, transcatheter transfemoral valve-in-valve can be recommended in patients with high surgical risk [2, 5]. Although traditional redo mitral valve replacement (MVR) remains the gold standard strategy for degenerative bioprosthetic valves, it is associated with significant complication rates, with mortality rates approaching 11% [6]. Therefore, transcatheter methods should always be considered for patients who may be considered inoperable.

An observational registry study compared surgical options with transcatheter methods for degenerative bioprosthetic valves and found that the transcatheter group had lower mortality and higher technical success rates [7]. Given the continuous increase in life expectancy, it is anticipated that the number of patients requiring intervention due to degenerative bioprosthetic valves will rise in the coming years. Many of these patients may not be surgical candidates due to various factors such as age, frailty, and comorbidities, making transcatheter methods a less invasive treatment option.

Complications that may arise during the procedure should be considered, and rescue strategies should be predetermined. One of the most serious complications of the procedure, LVOT obstruction, should be closely monitored, and in case of its development, emergency surgery, alcohol septal ablation, or the Rescue LAMPOON technique (Laceration of the Anterior Mitral leaflet to Prevent Outflow Obstruction) should be considered [8]. Therefore, the procedure should be performed in comprehensive heart valve centers.

Valves previously used for aortic valve positions can also be utilized for MVIV procedures. Additionally, various valves specifically designed for implantation via a transseptal approach for mitral valves have been developed. The most commonly used valves are the SAPIEN balloon-expandable valves (SAPIEN, SAPIEN XT, and SAPIEN 3, Edwards Lifesciences, Irvine, USA) [9]. Another balloon-expandable valve, the MyVal valve, is primarily used for TAVR, but there are case reports available supporting its use for MVIV [10, 11]. Due to its short profile and wide range of size options, it can be used in carefully selected patients for MVIV.

Although these interventions were initially designed for patients at prohibitive surgical risk, advancements and maturation of these technologies are expected to lead to increased consideration of these techniques and approaches for broader and lower-risk populations.

Successful ViV TMVR can be performed in most cases using a transseptal approach in a minimally invasive manner. This minimally invasive approach has demonstrated promising outcomes, including improved hemodynamics and symptom relief, with a reduced risk of complications compared to traditional redo surgical mitral valve replacement. As the technology and techniques continue to evolve, MVIV is expected to become a more widely adopted treatment strategy, providing a viable alternative for patients who are inoperable or at high risk for conventional surgery. Careful patient selection, pre-procedural planning, and the expertise of comprehensive heart valve centers are crucial to optimizing the success of this procedure and managing potential complications such as left ventricular outflow tract obstruction. The increasing life expectancy and the prevalence of bioprosthetic valve degeneration highlight the growing importance of transcatheter solutions in the future of cardiac care.