Transcatheter aortic valve replacement (TAVR) is a reliable treatment option for pa- tients with severe symptomatic aortic stenosis and high surgical risk ( ). It is still common that patients present acutely with untreated aortic stenosis (AS) complicated by cardiogenic shock (CS), representing an extremely high-risk population with a dismal prognosis ( ). Nevertheless, these patients have been excluded from randomized trials evaluating therapies targeting both aortic stenosis and heart failure, and their best management remains extremely challenging. Actually, in hemodynamically unstable patients with concomitant AS, it is recommended balloon aortic valvuloplasty (BAV) as a bridge to surgical aortic valve replacement (SAVR) or TAVR or as a palliative measure (class IIb recommendation) ( ). However, BAV is still associated with an high rate of mortality ( ). In the light of that and the improvements in TAVR procedure, it is reasonable to consider TAVR as first-line therapy in patients with CS, but more data are necessary.