Heart valve disease can occur in any of the four valves of the heart (pulmonary, mitral, aortic, or tricuspid), and it can lead to heart failure. The most common treatment for heart valve disease is open-heart surgery to replace the damaged valve with an artificial one. However, a common type of artificial valve, called a bioprosthetic valve, lasts only about 10 to 15 years.

Transcatheter valve-in-valve implantation is a less invasive treatment for people whose first bioprosthetic valve is failing and who cannot have another surgery or are at high risk for a poor outcome from another open-heart surgery. With transcatheter valve-in-valve implantation, cardiologists insert a catheter (a tube) into a large vein and thread the new valve through the vein, up into the heart. The new valve is placed inside the old valve, and it pushes the old valve out of the way.

This health technology assessment looked at how safe and effective transcatheter valve-in-valve implantation is for adults with failing mitral or tricuspid bioprosthetic valves who cannot have surgery or are high-risk for surgery. It also looked at the budget impact of publicly funding transcatheter valve-in-valve implantation. And it considered the experiences, preferences, and values of adults with failing mitral or tricuspid bioprosthetic valves.