Transcatheter aortic valve implantation is increasingly used to treat bioprosthetic degeneration. Valve-in-valve technique has been performed successfully to treat homograft, stentless, and stented bioprosthetic dysfunction. The presence of a prosthesis in the mitral position can make the transcatheter aortic valve implantation procedure challenging due to proximity of the mitral and aortic annuli. We describe the case of a 66-year-old who underwent the first successful implantation of Edwards Sapien device in a failing homograft in the presence of a mechanical mitral valve prosthesis.
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