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How should I treat a small, failing surgical bioprosthesis in a high surgical risk patient?

In collaboration with EuroIntervention Journal

A 77-year-old female who underwent surgical aortic valve replacement with a 21mm Mosaic bioprosthesis 13 years prior presented with worsening dyspnea on exertion. The patient was considered high surgical risk, so surgical valve replacement as well as valve-in-valve transcatheter aortic valve implantation were discussed as a treatment options.