Aortic valve replacement has traditionally involved open-heart surgery. In some patients with severe aortic stenosis, a prosthetic valve can be implanted using a transcatheter approach without a sternotomy. This method is known as TAVI (transcatheter aortic valve implantation).
The procedure is used in patients with severe aortic stenosis, in whom valve narrowing impairs blood flow from the left ventricle. During the procedure, a biological prosthetic valve is delivered to the heart through vascular access, most commonly via the femoral artery, and positioned within the diseased aortic valve.
What Is TAVI and How Does the Aortic Valve Work?
TAVI, or transcatheter aortic valve implantation, is an interventional cardiology procedure. During the procedure, a biological prosthetic valve is delivered to the aortic valve through a catheter and deployed inside the diseased native valve.
The aortic valve is located between the left ventricle and the aorta. During systole, it opens to allow blood to flow from the left ventricle into the aorta. During diastole, the valve closes to prevent blood from flowing backward.
In aortic stenosis, the valve leaflets thicken and may become calcified, narrowing the valve opening. To overcome this resistance, the left ventricle generates higher pressure. Prolonged pressure overload can lead to myocardial remodelling and impaired cardiac function.
In severe symptomatic aortic stenosis, valve replacement is one of the main treatment options. Depending on the clinical situation and the patient's anatomy, treatment may involve transcatheter aortic valve replacement or surgical valve replacement.
Who May Be Recommended for TAVI?
TAVI is considered for patients with severe aortic stenosis who require valve intervention and whose anatomy is suitable for transcatheter implantation.
The choice between TAVI and surgical aortic valve replacement (SAVR) is made on an individual basis. According to the 2025 ESC/EACTS Guidelines, the decision takes into account the patient's age, life expectancy, comorbidities, the anatomy of the aortic valve and aortic root, vascular access feasibility, procedural risks, and the potential need for future interventions.
For patients with a tricuspid aortic valve and suitable anatomy, TAVI may be considered as a treatment option from the age of 70, regardless of surgical risk. In younger patients, the choice of procedure requires particular attention to the long-term treatment strategy. In patients with a bicuspid aortic valve, anatomical features and the technical feasibility of TAVI must also be assessed. The final decision is made after a comprehensive evaluation and discussion of the case by cardiologists, cardiac surgeons, and other specialists involved in the patient's care.
How to Prepare for Aortic Valve Replacement
Preparation for TAVI involves assessing the heart, the aortic valve, and the blood vessels through which the delivery system will be advanced.
Echocardiography helps determine the severity of aortic stenosis, assess left ventricular function, and identify associated valve abnormalities. Computed tomography angiography is used to examine the anatomy of the aortic annulus, aortic root, and peripheral vessels in detail.
CT findings help determine the appropriate prosthetic valve size, identify the optimal access route, and assess anatomical factors associated with the risk of coronary obstruction and other complications.
Before the procedure, clinicians also assess comorbidities, kidney function, and other factors that may affect the intervention. The management of anticoagulants, antiplatelet agents, and other medications is agreed upon with the treating physician.
How Is the TAVI Procedure Performed? Key Steps
TAVI is most commonly performed through the femoral artery. The delivery system is introduced through the vascular access site and advanced towards the aortic valve under fluoroscopic guidance. Its position is monitored throughout advancement towards the heart.
Before implantation, preprocedural imaging is used to determine the required prosthesis position and positioning parameters. Once the delivery system reaches the aortic valve, the prosthesis is deployed inside the diseased native valve.
Various systems are used for transcatheter aortic valve replacement, including prostheses from the Medtronic range. One example is the CoreValve Evolut R, a self-expanding biological prosthetic valve delivered through a catheter using a dedicated delivery system.
The Evolut R design allows controlled deployment, recapture of the prosthesis, and repositioning at the appropriate stage of implantation. This makes it possible to adjust the valve's position if the initial placement requires correction, provided the manufacturer's instructions are followed. According to the manufacturer, up to 80% of the deployment allows the valve to be recaptured and repositioned if necessary. This can be done up to three times under specified conditions of system use.
After implantation, clinicians assess the position and function of the prosthesis, transvalvular blood flow, and the presence of paravalvular regurgitation. The vascular access site is also monitored, along with any potential early complications.
Benefits and Potential Risks of TAVI
TAVI does not require a sternotomy or direct surgical access to the heart. With the transfemoral approach, the prosthesis is delivered to the aortic valve through a peripheral blood vessel. This reduces surgical trauma and may allow faster recovery compared with surgical valve replacement.
Comparative studies indicate that the incidence of certain early complications is lower after transfemoral TAVI than after surgical aortic valve replacement. These include major bleeding, acute kidney injury, and new-onset atrial fibrillation. However, outcomes depend on the patient's clinical characteristics, anatomy, access route, and other factors.
Potential complications of TAVI include bleeding and vascular injury at the access site, stroke, atrioventricular and intraventricular conduction disturbances that may require permanent pacemaker implantation, and paravalvular regurgitation.
The risk of these complications depends on the individual patient's anatomical and clinical characteristics. Therefore, the choice between TAVI and surgical aortic valve replacement is based on a comprehensive assessment of expected benefits, procedural risks, and the long-term treatment strategy.
Recovery After TAVI and Follow-Up Care
Recovery after TAVI is generally faster than after surgical aortic valve replacement, particularly when the transfemoral approach is used. The length of hospitalisation depends on the patient's condition, the procedural approach, and the presence of early complications.
After implantation, clinicians monitor prosthetic valve function, heart rhythm, the vascular access site, and potential complications. Follow-up appointments and echocardiography are performed according to the patient's clinical condition and the treating physician's recommendations. Patients should adhere to their prescribed antithrombotic therapy and other recommendations for ongoing care.
TAVI has expanded the treatment options for severe aortic stenosis by offering an alternative to open-heart surgery for patients who are suitable for a transcatheter approach. The choice of treatment is based on an individual assessment of anatomy, clinical risk, and long-term prognosis.
Zhanna Odynska, a patient, shared her experience of minimally invasive aortic valve replacement (TAVI) with COR-Medical Life.