The strategy for bivalvular interventions in aortic stenosis and concomitant mitral regurgitation

Multivalvular heart disease represents a less explored domain within cardiovascular surgery. In patients with aortic stenosis (AS) undergoing surgical or transcatheter aortic valve replacement (TAVR), the prevalence of moderate to severe mitral regurgitation (MR) ranges from 8% to 33%. Among the most common presentations are patients with severe AS and clinically significant functional MR. In instances of moderate surgical risk, open-heart surgery is typically performed, sometimes involving combined valve correction procedures. However, for patients deemed to be at high surgical risk or deemed inoperable, an interventional approach may be considered if the anatomy of both the aortic and mitral valves is conducive to such intervention. Careful analysis of each patient is essential in determining the appropriate treatment strategy, whether it involves isolated TAVR or if a staged intervention targeting the aortic and mitral valves is warranted. In the article, we present a review of the literature devoted to the strategy for bivalvular interventions in patients of high surgical risk and also a clinical case of a successful step-by-step interventional approach in an 83-year-old patient of high surgical risk with hemodynamically significant aortic and mitral valve disease, along with an analysis of the chosen approach.