Transcatheter Double Valve Replacement of an Aortic and Mitral Valve in the Native Annulus

•This procedure is an alternative to surgical intervention in the high-risk or nonoperable patient.•Procedural success is improving and highly dependent on selecting the right candidate, with near circumferential annular calcification for valve anchoring and large LVOT that accommodates the valve stent and the anterior leaflet, neo-LVOT >189.4 mm2.•In contrast to surgical replacement, the aortic valve is replaced first prior to mitral valve replacement.•Preoperative cardiac gated CT scanning remains the most commonly used method for valve sizing and planning.•LVOT obstruction and valve embolization carry a substantial risk of morbidity and mortality but can be avoided with careful planning.•Alcohol septal ablation, possibly aided by percutaneous ventricular support devices, can help in the acute setting and can be an alternative to surgical bailout when LVOT obstruction occurs.