What is Known: Atrioventricular valve regurgitation (AVVR) is a devastating complication in children and young adults with congenital heart disease (CHD), particularly in patients with single ventricle physiology. Transcatheter edge-to-edge repair (TEER) is a rapidly expanding, minimally invasive option for the treatment of AVVR that avoids the morbidity and mortality associated with open heart surgery. AVVR in CHD patients is a complex problem. An organized approach is required if the potential of TEER therapy is ever to be realized in this heterogenous population. What is New: We demonstrate an image-derived modeling protocol and clinically successful application of TEER in four patients with CHD including three patients with palliated single ventricle physiology and a Fontan circulation. What is Next: The protocolized approach to TEER in CHD described in this report may serve as a foundation for the safe initiation of TEER therapy at other free-standing pediatric hospitals. Further collaborative investigations of the use of TEER in this challenging population are warranted. Ideally, a multicenter study will ensue.

• Decisions surrounding if, and when, to perform coronary revascularization in patients undergoing trans-catheter aortic valve replacement (TAVR) are often complex.

• Concomitant percutaneous coronary interventions (PCI) and TAVR is associated with comparable technical success, but higher rates of bleeding and acute kidney injury, compared to staged procedures or no PCI.

• Timing of PCI relative to TAVR should be individualized based on clinical status, lesion complexity and anticipated risks of bleeding and renal injury.