Totally endoscopic aortic valve replacement after open surgical and subsequent transcatheter aortic valve replacement.

Transcatheter aortic valve replacement is increasingly being offered to younger and lower risk patients, including patients with previous surgical aortic valve replacement. The long-term outcome of valve-in-valve transcatheter aortic valve replacement after surgical valve replacement remains uncertain. We present the case of a fully thoracoscopic redo aortic valve replacement for symptomatic valve-in-valve stenosis after previous open surgical aortic valve replacement and secondary valve-in-valve transcatheter aortic valve replacement. This procedure has proven to be difficult and high risk, in part due to the redo nature of the operation and the extensive neo- endothelialization over the transcatheter aortic valve replacement stent frame. This article demonstrates the feasibility of a minimally invasive approach for transcatheter aortic valve replacement and bioprosthetic valve explant while simultaneously highlighting the essential role of the heart team in selecting the correct treatment strategy for patients with bioprosthetic valve degeneration.