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Aims Methods and results Conclusions Lung ultrasound (LUS) is a sensitive tool to assess pulmonary congestion (PC). Few data are available on LUS‐PC evaluation in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). The aim of this study was to assess the prevalence and prognostic impact of LUS‐PC in patients with severe AS before and after TAVI.We designed a single‐centre prospective study in patients referred for TAVI for severe AS (ClinicalTrials.gov identification number: NCT05024942). All patients underwent echocardiography and LUS (according to a simplified 8‐zone scanning protocol) the day before and within 72 h after the procedure. The primary endpoint was the composite of all‐cause mortality, hospitalization for heart failure and urgent medical visits for worsening dyspnoea at 12‐month follow‐up. A total of 127 patients were enrolled (mean age 81.1 ± 5.8 years; 54.3% female). Pre‐TAVI LUS‐PC was documented in 65 patients (51%). After TAVI, the prevalence of LUS‐PC significantly decreased as compared to pre‐TAVI evaluation, being documented in only 28 patients (22% vs. 51%, p < 0.001) with a median B‐lines score of 4 (interquartile range [IQR] 0–11) versus 11 (IQR 6–19) pre‐TAVI (p < 0.001). During a median follow‐up of 12 (12–17) months, 25 patients (19.6%) met the composite endpoint. On multivariable Cox regression analysis, pre‐TAVI LUS‐PC was independently associated with cardiovascular events (hazard ratio 2.764, 95% confidence interval 1.114–6.857; p = 0.028).Lung ultrasonography reveals a high prevalence of PC in patients with severe AS undergoing TAVI, which is significantly reduced by the procedure. Pre‐TAVI PC, measured by LUS, is an independent predictor of 1‐year clinical outcome. [ABSTRACT FROM AUTHOR]

Valvular heart diseases (VHD) are common in the elderly population and several therapeutic options are available to treat them. When selecting the management strategy for VHD patients, to evaluate the operatory risk, using special scores like STS score, EuroSCORE II and other more specific ones is pivotal. However, the risk scores do not consider some aspects, such as the clinical needs of the single patients, the management of local resources and the expertise of the center. The Heart Team, combining the experience of various specialists, can optimize the decision-making process through a better evaluation of the risk/benefit ratio of the therapeutic choices. The multidisciplinary discussion of the most complex cases is recommended by the international guidelines for the management of VHD and it is part of the clinical practice of many centers. So far, both trials and large clinical studies supporting such multidisciplinary management are lacking. Despite these important limitations, the Heart Team can be actually regarded as a promising tool to locally promote best practices for the treatment of VHD patients.