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Double Valve Surgery Reduces Heart Failure Readmissions Compared to Isolated Transcatheter Aortic Valve Replacement

Marco Tagliafierro¹, Rahul Kanade¹, Darina Kirilina¹

¹Columbia University Irving Medical Center, Cardiac Surgery, Room 7-435, Milstein Hospital Building, 7th Floor, 177 Fort Washington Avenue, New York, NY 10032, United States.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery

|February 23, 2026

Abstract

Objectives:

Patients with concomitant severe aortic stenosis (AS) and moderate/severe mitral stenosis (MS) pose a complex therapeutic challenge. While double valve surgery (DVS) remains the gold standard, its high operative risks have led to investigating novel strategies, chiefly transcatheter interventions. Due to the lack of commercially available transcatheter devices for MS, numerous high-risk patients undergo isolated transcatheter aortic valve replacement (I-TAVR). The long-term efficacy and durability of this single-valve approach in a multivalvular stenotic setting is not well established.

Methods:

Retrospective analyses of consecutive patients treated for concomitant severe AS and moderate-to-severe MS at a single institution (2015-2025), divided according to treatment strategy (DVS vs I-TAVR). Propensity-score matching accounted for baseline differences, while univariable and multivariable analyses evaluated factors associated with recurrent heart failure (HF) readmissions.

Results:

Ninety-seven patients underwent DVS and 129 I-TAVR. Both before and after propensity score matching, no differences were observed in short- nor mid-term incidence of all-cause mortality (unmatched, P = .078; matched, no events) nor stroke (unmatched, P = .783; matched, P = 1.00). However, I-TAVR was found to be associated with greater HF rehospitalizations (unmatched, P = .001; matched, P = .006). The univariable and multivariable analyses demonstrated I-TAVR to be an independent risk factor for HF rehospitalization, in both the unmatched and matched populations.

Conclusions:

In patients with high-grade concomitant AS and MS, addressing only AS with I-TAVR is an independent predictor of HF readmissions. While I-TAVR remains a valid therapeutic option in high-risk patients with high-grade multivalvular stenosis, DVS should be considered as the preferred treatment option in any patient that can tolerate surgery.

Institutional Review Board (Irb) Number:

IRB-AAAV5910. Consent was waived owing to the retrospective design of the study.

Keywords:

TAVI double valve surgery heart failure moderate-severe mitral stenosis multivalvular disease readmission severe aortic stenosis transcatheter aortic valve replacement

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