Symptomatic patients with bioprosthetic valve regurgi- tation are best managed by surgery, with a transcath- eter ViV procedure if the patient is at high or prohibitive risk. Because of rapid progression of bioprosthetic re- gurgitation, replacement of a leaking bioprosthesis may be considered even in the asymptomatic patient. Recommendation-Specific Supportive Text 1. Surgery is a viable therapeutic option in many patients with symptomatic paravalvular leak and is associated with reasonable outcomes.1 The risks associated with surgical intervention depend on the procedure required, be it suture repair or CLINICAL STATEMENTS AND GUIDELINES repeat AVR. Although surgical reoperation is asso- ciated with acceptable mortality and morbidity rates in the current era, it still carries a higher risk than the initial surgery. Kaneko and colleagues examined a cohort of 3380 patients from the STS database (2011 2013) who underwent elective isolated reoperative AVR, and they demonstrated a higher (but acceptable) operative mortality rate than that seen with initial AVR (4.6% versus 2.2%; P<0.0001) and relatively low complication This was true even among octogenarians who underwent reoperative AVR.3 In a cohort of 136 consecutive patients who underwent surgical correction for a non endocarditis-related aortic or mitral paravalvular leak (1986 2001), surgical correction of the paravalvular leak was associ- ated with acceptable operative mortality (6.6%) and morbidity rates.1 More recently, Shah and colleagues reported an operative mortality rate of 3% among 495 patients undergoing surgery for paravalvular leak,14 with higher risk associated with mitral than with aortic valve procedures (odds are consistent with the findings of Bouhout and who reported operative mortality rates of 8% among mitral valve, 3% among aor- tic valve, and 14% among double-valve patients in a total cohort of 190 patients undergoing sur- gery indicated for paravalvular leak. 