Of the survivors, 93% experienced good functional status (NYHA class I or II), with an overall 1-year survival rate of Some systematic reviews comparing outcomes of transcatheter ViV with those of repeat SAVR suggest that hemodynamic outcomes are similar, but stroke and bleeding risks are lower with ViV.15 There is a subset of patients with bioprosthetic valve stenosis attributable to thrombus on the leaflets who may respond to oral anti- coagulation with a VKA (Figure 14).6 13 Recommendation-Specific Supportive Text 1. Reoperative surgery for prosthetic valve stenosis is associated with acceptable mortality and morbid- ity rates in the current era, but the risks are typi- cally higher than those estimated at the time of initial surgery because of older patient age, clini- cal status at the time of intervention, and reop- The decision to proceed with surgical versus transcatheter intervention is based on available expertise, individual patient and valve characteristics, and shared decision-making. 2. Catheter-based therapy with transcatheter ViV has emerged as an acceptable alternative to reopera- tive surgery for the treatment of high and prohib- itive surgical risk patients with bioprosthetic AS.4,5 Although coronary artery obstruction is more com- mon with aortic ViV procedures than with TAVI for native AS, rates of paravalvular leak and permanent pacemaker implantation are lower with aortic ViV procedures than with TAVI for native AS. Annulus rupture has not been reported. Transcatheter ViV also has been successfully performed for failed surgi- cal bioprostheses in the mitral, pulmonic, and tricus- pid positions, although LV outflow obstruction may occur after mitral ViV implantation. 3. A subset of patients presents with stenosis of a bioprosthetic valve attributable to leaflet throm- bosis that results in decreased mobility of the leaf- lets. Leaflet thrombosis can occur from 1 month to years after implantation. 