Transcatheter aortic valve implantation could represent an alternative option to conventional surgery in high-risk patients with degeneration of aortic bioprosthesis. Herein, we report the performance of a valve-in-valve procedure in urgent conditions and via the left axillary artery in a patient with patent left internal mammary artery coronary graft. A 23-mm Edwards Sapien® transcatheter valve was deployed within a 23-mm Edwards Magna Ease bioprosthesis through the novel Edwards 16-F expandable introducer. In this non-elective case, the expandable introducer allowed a safe procedure, reduced the risk of subclavian injury, and preserved the left internal mammary artery graft flow. © 2012 Wiley Periodicals, Inc.