Table 59. Multivalvular disease: Recommendations^{1,2,163–165}.

Intervention	Clinical condition	SBC	AHA	ESC
Percutaneous balloon mitral valvuloplasty	Severe symptomatic MS with favorable anatomy and aortic moderate lesion	I A	–	–
Surgical treatment/valve replacement	Symptomatic multivalvular disease	I B	I B	I B
	Multivalvular disease with prognostic factors	IIa C	–	–
	Treatment of moderate valve lesion concomitant to treatment of severe valvular disease or other cardiac or ascending aorta surgery	I C	I C	I C
Transcatheter treatment – valve-in-valve	Mitral and aortic biological prosthesis dysfunction with symptoms and high surgical risk	IIb C	–	–
	Mitral and aortic biological prosthesis dysfunction with prognostic factors and high surgical risk	IIb C	–	–
Transcatheter treatment – TAVI and percutaneous mitral repair	Severe AS and severe primary MR with symptoms and high surgical risk	IIb C	–	–
	Severe AS and severe primary MR with prognostic factors and high surgical risk	IIb C	–	–

AHA: American Heart Association; AS: aortic stenosis; MR: mitral regurgitation; MS: mitral stenosis; ESC: European Society of Cardiology; SBC: Sociedade Brasileira de Cardiologia (Brazilian Society of Cardiology); TAVI: transcatheter aortic valve implantation.