Staged Transcatheter Treatment of Combined Aortic and Mitral Regurgitation: A Downstream Approach.

BACKGROUND: Concomitant severe aortic (AR) and mitral regurgitation (MR) affects up to 25% of patients with aortic valve disease and portends poor prognosis. Evidence on a sequential downstream approach in native AR is limited. CASE SUMMARY: We report 4 patients with high surgical risk (mean age 82 years, Society of Thoracic Surgeons score >8) with severe AR and MR treated with transcatheter aortic valve replacement for native AR. In 2 patients with secondary MR, AR correction was followed by reverse remodeling and downstaging of MR from severe to moderate, avoiding mitral transcatheter edge-to-edge repair. In the remaining 2 patients, MR remained severe, and staged mitral transcatheter edge-to-edge repair was performed. DISCUSSION: These cases support the hypothesis that MR etiology, rather than AR correction alone, determines whether MR regresses after isolated AR treatment. TAKE-HOME MESSAGE: MR etiology and post-transcatheter aortic valve replacement reassessment may guide a staged transcatheter strategy, sparing unnecessary mitral intervention in inoperable patients with combined AR/MR.