This narrative review examines when patients disqualified from transcatheter aortic valve implantation (TAVI) should be referred to palliative care, offering practical guidance for Heart Team decision-making. A targeted search of PubMed and Scopus (2010–2025) was conducted, integrating palliative care practice and brief clinical vignettes. Recurrent triggers for palliative referral include advanced frailty likely to limit recovery, multimorbidity with refractory symptoms, patient or family preference for comfort-focused treatment, and anatomical or physiological unsuitability for TAVI confirmed by a multidisciplinary Heart Team. Best-practice themes include early symptom-directed pharmacotherapy, comprehensive psychosocial and spiritual support, explicit documentation of care goals, and coordinated transitions to community or home-based services. Early, structured collaboration among cardiology, cardiac surgery, and palliative medicine can optimise quality of life, minimise futile interventions, and ensure continuity of care in patients with TAVI-ineligible severe aortic stenosis. Prospective studies should validate integration models and quality indicators to ensure their effectiveness.