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Balloon aortic valvuloplasty (BAV), first introduced by Cribier et al. in 1986, has seen a resurgence in popularity in the transcatheter aortic valve replacement (TAVR) era. Thanks to improved training and technical advances, BAV is now safer, with periprocedural mortality of 2.2% and inhospital mortality of 7.1%, and rates of stroke of 1.1%, severe aortic regurgitation of 1.1% and major vascular complications of 7.0%, even though today’s patients are more complex and hemodynamic improvement remains modest. Given the increasing use of TAVR, the main challenges of BAV nowadays are related to organization of the heart team to treat aortic stenosis, the most common valve disease in developed countries. Portugal’s population currently includes around a million people aged over 75 years, 3.4% of whom present severe aortic stenosis and of these, 75% are symptomatic. Of these 25 000 individuals, around 4500 will have indication for TAVR due to high surgical risk or inoperability, according to the guidelines on valvular heart disease. The Portuguese TAVR registry includes around

Balloon aortic valvuloplasty in the transcatheter aortic valve replacement era: A challenge to organization of the heart team