Early Versus Deferred Aortic Valve Replacement in Patients With Moderate Aortic Stenosis and Mitral Regurgitation

Who can take part

• Age ≥18 years
• Moderate native aortic stenosis defined by an aortic valve area (AVA) ≤1.5 cm2 and >1.0 cm2 and transvalvular mean gradient ≥20 mmHg and <40 mmHg
• Primary or secondary mitral regurgitation (at least moderate) defined by effective regurgitant orifice area (EROA) ≥20 mm2 or regurgitant volume ≥30 ml
• New York Heart Association (NYHA) functional class ≥2

Who cannot take part

• Transcatheter or surgical treatment of valvular and/or coronary artery disease within 90 days prior to randomization
• COPD with home oxygen therapy
• Stroke within 30 days prior to the randomization
• Life expectancy <1 year irrespective of valvular heart disease
• Severe tricuspid valve disease requiring intervention
• Patients with severe secondary MR who remain symptomatic despite optimal medical therapy and who are judged appropriate for transcatheter edge-to-edge repair or surgery by the Heart Team
• Left ventricular ejection fraction <30% or LVESD >70mm
• Echocardiographic evidence of severe right ventricular dysfunction
• Untreated clinically significant CAD requiring revascularisation
• Moderate or severe aortic regurgitation
• Symptomatic patients with severe primary MR who are operable and not high risk
• Estimated or measured systolic PAP >70 mmHg
• Inability to provide written informed consent
• Participation in another cardiovascular trial before reaching the primary endpoint