Aortic Stenosis and Mitral Regurgitation: Takeaways From the Heart Valve Collaboratory Workshop on Multivalvular Disease.

The management of multivalvular disease presents increasing challenges in clinical practice caused by complex hemodynamic interactions and limited guideline-based recommendations. As part of the inaugural collaboration between JACC and the Heart Valve Collaboratory (HVC), this paper synthesizes key insights from the 2024 HVC workshop focused on concomitant aortic stenosis + mitral regurgitation. The document outlines the burden of disease, limitations of current surgical and transcatheter approaches, and variability in clinical decision-making caused by gaps in evidence. A major focus of the workshop was identifying unmet needs in patient selection, timing and sequencing of interventions, imaging, and prediction of mitral regurgitation response after transcatheter aortic valve replacement. The paper highlights unresolved clinical questions and proposes a research agenda including the establishment of prospective registries, randomized trials comparing staged vs concomitant therapy, and use of artificial intelligence for imaging analysis and risk prediction. By bringing together multidisciplinary expertise and outlining priorities for future investigation, this initiative seeks to advance the standardization and personalization of multivalvular disease management. These efforts aim to improve outcomes for patients with complex valve disease and serve as a framework for addressing other multivalve combinations in future research.