AVR for AS reduces LV pressure, thereby reducing the pressure gradi- ent that propels volume across the incompetent mitral valve. Although it is reasonable to expect that AVR would reduce MR by reducing LV systolic pressure, this fails to occur in many cases. Not sur- prisingly, primary MR is more likely to persist after AVR than is secondary MR because AVR does not correct intrinsic mitral valve disease.1 5 Therefore, in patients with both AS and MR who are at a low or intermediate surgical risk, it is reasonable to address both valves with surgery. This is particularly true if the mitral valve can be repaired.1 For patients with both AS and severe primary MR in whom the mitral valve cannot be repaired, a deci- sion about treatment of the MR will need to be made by the MDT, taking into consideration mul- tiple factors, including the additive risk of a mitral valve replacement. Mitral TEER at a later date may be an option but is likely to have a suboptimal result if the valve cannot be surgically repaired. Thus, double valve replacement with both AVR and mitral valve replacement would be an option if they can be performed at an acceptable level of risk, given that the outcome of the MR after AVR is uncertain. Patients with severe AS who are at high to prohibi- tive surgical risk are best served by TAVI. 