Bioprosthetic valves will fail, given enough time. All prosthetic valves, whether mechanical or biological, are beset with nonstructural valve deterioration due to such causes as infective endocarditis and pannus formation, but bioprosthetic valves are uniquely prone to structural valve deterioration (SVD) caused by calcification or wear, leading to either stenosis or regurgitation (Figure 1, A and B). 1 The combination of SVD and non-SVD constitutes what is now termed bioprosthetic valve failure (BVF). 2 A transcatheter approach to SVD using the valve-in-valve (VIV) procedure is now well accepted for the treatment of SVD. But should aortic VIV be the preferred procedure for most patients?