Procedural Sequence in Simultaneous TAVR and PBMV: A 3-Patient Case Series

Combined aortic stenosis (AS) and mitral stenosis (MS) present a challenging multivalvular disease scenario. Simultaneous transcatheter aortic valve replacement (TAVR) and percutaneous balloon mitral valvuloplasty (PBMV) has emerged as a potential option for selected high-risk patients, but the optimal procedural sequence remains unclear. We describe 3 patients with severe AS and MS who underwent combined TAVR and PBMV following heart team evaluation, with a focus on procedural sequencing. Postprocedural hemodynamics improved immediately, and short-term outcomes were satisfactory. Our experience suggests that a TAVR-first strategy may provide superior hemodynamic stability and facilitate more accurate assessment of PBMV endpoints in selected patients with combined AS and MS.