Intervention for Prosthetic Valve Stenosis Recommendations for Intervention for Prosthetic Valve Stenosis Referenced studies that support the recommendations are summarized in Online Data Supplement 40. COR LOE Recommendations In patients with symptomatic severe stenosis of a bioprosthetic or mechanical prosthetic valve, repeat surgical intervention is indicated unless surgical risk is high or prohibitive.1 3 For severely symptomatic patients with bioprosthetic aortic valve stenosis and high or prohibitive surgical risk, a transcatheter ViV procedure is reasonable when performed at a Comprehensive Valve Center.4,5 For patients with significant bioprosthetic valve stenosis attributable to suspected or documented valve thrombosis, oral anticoagulation with a VKA is reasonable.6 13 Synopsis Cumulative survival rates are higher with reoperative AVR than with transcatheter ViV treatment for prosthetic valve stenosis, and a surgical approach is associated with a re- duced incidence of patient prosthesis mismatch, reduced incidence of paravalvular leak, and lower aortic valve gra- The VIVID (Valve-In-Valve International Data) reg- istry examined outcomes with ViV treatment of 459 pa- tients, of whom 40% had isolated stenosis and 30% had Within 1 month after the ViV procedure, 7.6% of patients died and 1.7% had a major stroke. 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. 