In patients with a bioprosthetic TAVI, TTE annually is reasonable. Table 21. AS/MR Mixed Valve Disease Severe AS Severe MR Surgical Risk Procedure SAVR candidate Primary MR Repairable valve Low intermediate SAVR Surgical mitral valve repair SAVR candidate Primary MR Valve not repairable Low intermediate SAVR Surgical mitral valve replacement TAVI candidate Primary Repairable valve High prohibitive TAVI Mitral TEER* SAVR candidate TAVI candidate Secondary MR Low intermediate SAVR Surgical mitral valve repair/mitral valve replacement or TAVI Mitral TEER* TAVI candidate Secondary MR High prohibitive TAVI Mitral TEER* *Consider TEER as a later staged procedure if symptoms and severe MR persist after treatment of the AS. AS indicates aortic stenosis; MR, mitral regurgitation; SAVR, surgical aortic valve replacement; TAVI, transcatheter aortic valve implantation; and TEER, transcatheter edge-to-edge repair. CLINICAL STATEMENTS AND GUIDELINES Synopsis The clinical course of patients with prosthetic heart valves or repaired native valves is influenced by several factors, including ventricular function, AF, pulmonary hypertension, and CAD, as well as by the development of valve-related complications. The interval between routine follow-up visits depends on the patient s valve type, the presence of residual heart disease, and other clinical factors. Attention to optimal dental care and en- docarditis prophylaxis and any needed anticoagulation is a requisite component of care. TTE is the primary imaging modality for postopera- tive assessment of prosthetic valve or repaired native valve function. In the absence of early complications, the index study is performed during hospitalization or within the first several weeks thereafter, depending on individual patient circumstances and the type of valve procedure. Additional imaging, such as TEE, cardiac CT, or fluoroscopy, may be required when valve dysfunc- tion is suspected and in the context of the clinical pre- sentation. 