The National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Transcatheter valve-in-valve implantation for aortic bioprosthetic valve dysfunction, in September 2014.


The 2 main indications for aortic valve replacement are aortic stenosis and aortic regurgitation. Symptoms of aortic stenosis and regurgitation typically include shortness of breath and chest pain on exertion. The increased cardiac workload can lead to heart failure.

Surgical aortic valve replacement (SAVR) with an artificial prosthesis (biological or mechanical) is the conventional treatment for patients with severe aortic valve dysfunction who are well enough for open heart surgery. Although bioprosthetic valves have some advantages over mechanical valves, they may degenerate and fail over time. The standard treatment for a failed bioprosthetic valve is repeat open heart surgery, with a further valve replacement. Re-operative surgery is associated with significant morbidity and a higher risk of mortality than primary surgery. Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) has been developed as a less invasive alternative treatment that avoids the need for cardiopulmonary bypass. It can be used for the treatment of failed bioprosthetic aortic valves originally placed either by transcatheter aortic valve implantation (TAVI) or by open heart surgery. In particular, it has been used for rescue of suboptimal TAVI.

Coding recommendations

Transluminal approach:

K26.8 Other specified plastic repair of aortic valve

Y79.- Approach to organ through artery

Y53.- Approach to organ under image control

U20.2 Transoesophageal echocardiography

Note: Codes within category Y53.- are used as secondary codes to classify interventions that are percutaneous and require some form of image control: if the method of image control is unspecified, Y53.9 Unspecified approach to organ under image control is assigned.

Transapical / transventricular approach:

K26.8 Other specified plastic repair of aortic valve

Y49.4 Transapical approach to heart

Y53.- Approach to organ under image control

U20.2 Transoesophageal echocardiography

The Clinical Classifications Service has advised NICE that currently these are the most suitable OPCS-4 codes to describe this procedure. The OPCS-4 classification is designed to categorise procedures for analysis and it is not always possible to identify a procedure uniquely.


Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

  • National Institute for Health and Care Excellence (NICE)