As transcatheter aortic valve replacement becomes a more dominant
treatment option across all risk profiles, the frequency of encountering
patients with multivalvular disease will increase. Furthermore,
percutaneous interventions to treat other valvular lesions are also
evolving. Understanding the clinical implications and treatment options
for a second valvular lesion is becoming increasingly important to guide
heart team decisions, and this paper aims to review the evidence around
these situations. Diagnosis of multivalvular disease can be challenging
because of changes in physiology. There are little randomized data to
guide therapy in multivalvular disease. Multidisciplinary heart team
decisions can be invaluable in integrating the plethora of clinical,
hemodynamic, and imaging data on which an optimal management strategy
can be planned. Prospective studies to assess the role of structural
valve interventions in the transcatheter aortic valve replacement era
would greatly help improve outcomes for structural heart patients.