• aortic stenosis;
  • valve replacement;
  • transcatheter valve;
  • mitral valve;
  • homograft

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. © 2013 Wiley Periodicals, Inc.