Valve-in-valve prosthesis—late morphological findings

•Data on durability of transcatheter aortic valve replacement (TAVR) bioprosthesis after the valve-in-valve (VIV) procedure are rare•Detailed examination of the explanted valves using a multimodal approach is essential in understanding the pathophysiology of tissue degeneration•Incomplete expansion of the inner prosthesis without malpositioning may be sufficient to cause the delayed morphologic alterations and functional consequences