A 64-year-old man with severe aortic stenosis and mitral regurgitation presented to our emergency. He had a New York Heart Association class IV symptoms with EuroSCORE II of 20%. Heart team decide to perform an urgent TAVR. The patient commenced cardiogenic shock in operation room. A Venus 22mm balloon and A 26mm Venus A-Valve were performed immediately. Aortography and TEE showed a deep implantation, moderate to severe “supra-skirt” paravalvular aortic regurgitation (PAR) and mild prosthetic aortic valve stenosis. After evaluating the hemodynamic tolerability of PAR and the initial mitral regurgitation, the heart team decided to proceed with aortic valve replacement and mitral valve replacement rather than valve-in-valve TAVR.