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

Inclusion Criteria: * 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 Exclusion Criteria: * Life expectancy \<1 year irrespective of valvular heart disease * 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 * Severe tricuspid valve disease requiring intervention * Symptomatic patients with severe primary MR who are operable and not high risk * 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 * Transcatheter or surgical treatment of valvular and/or coronary artery disease within 90 days prior to randomization * COPD with home oxygen therapy * Estimated or measured systolic PAP \>70 mmHg * Stroke within 30 days prior to the randomization * Inability to provide written informed consent * Participation in another cardiovascular trial before reaching the primary endpoint.