Transcatheter Aortic Valve Replacement (TAVR), also called Transcatheter Aortic Valve Implantation (TAVI), is a minimally invasive procedure used to treat severe aortic stenosis in patients who may not be ideal candidates for open-heart surgery. It has rapidly become one of the most important structural heart interventions worldwide, with rising procedure volumes, high success rates, and expanding indications in different age and risk groups.
What is TAVR and who needs it?
Aortic stenosis is a condition in which the aortic valve becomes narrowed and stiff, making it difficult for blood to flow from the left ventricle to the rest of the body. Over time this can lead to shortness of breath, chest pain, dizziness, fainting, heart failure, and even sudden death if left untreated. Severe symptomatic aortic stenosis has a poor natural prognosis, with studies showing annual mortality rates as high as 25–50 percent once symptoms develop if valve replacement is not performed.
TAVR offers an alternative to surgical aortic valve replacement (SAVR) by placing a new valve inside the diseased one using a catheter instead of opening the chest. Initially approved for patients at very high or prohibitive surgical risk, TAVR is now also used in intermediate and selected low-risk patients after large randomized trials showed noninferior or better outcomes compared with surgery in certain groups.
Fact 1: Valve is inserted through a catheter
During a TAVR procedure, a collapsible artificial valve (usually made from bovine or porcine tissue mounted on a metal stent) is delivered to the heart using a catheter, most commonly through the femoral artery in the groin (transfemoral approach). Under fluoroscopic and echocardiographic guidance, the catheter is advanced across the narrowed native valve and the new prosthetic valve is expanded using either balloon inflation or self-expansion, pushing the old leaflets aside and immediately restoring forward blood flow.
Other access routes, such as transapical (through a small incision in the chest and tip of the heart) or transaortic and transaxillary approaches, may be used if the femoral arteries are too narrow or heavily calcified, but transfemoral TAVR now accounts for the vast majority of cases worldwide because it is less invasive and associated with faster recovery.
Fact 2: Suitable option for higher-risk patients
TAVR was originally developed for patients considered inoperable or at very high risk for conventional open-heart surgery due to advanced age, frailty, lung disease, kidney problems, or multiple comorbidities. Landmark trials in such patients showed dramatic improvements in survival compared with medical therapy alone and comparable or better outcomes versus surgery in high-risk groups, leading to rapid adoption and inclusion in international valve guidelines.
Over time, evidence from large randomized trials in intermediate and selected low-risk patients demonstrated that TAVR could match or even outperform surgical replacement in terms of mortality, stroke, and quality-of-life outcomes at 1–5 years for appropriate anatomies. Today, heart teams often consider TAVR as a first-line option for many patients over 70–75 years, particularly when frailty or other conditions increase surgical risk.
Fact 3: TAVR allows for quicker recovery
Compared with traditional open-heart surgery, which requires a sternotomy (opening the chest bone) and use of a heart-lung machine, TAVR is significantly less invasive and usually does not require stopping the heart. Many patients undergo the procedure under conscious sedation rather than full general anesthesia, which also supports quicker mobilization and reduced intensive care stays.
Clinical data show that hospital length of stay after transfemoral TAVR is often 2–5 days in many centers, versus 7–10 days for surgical valve replacement, with some programs safely discharging selected low-risk patients within 24–48 hours. Most patients report improvement in symptoms such as breathlessness and fatigue within days to weeks, and many can resume light daily activities within 1–2 weeks, progressing to more normal routines within 4–8 weeks depending on age, baseline health, and any complications.
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Fact 4: Not everyone is a candidate for TAVR
Eligibility for TAVR is determined individually by a multidisciplinary heart team, which typically includes interventional cardiologists, cardiac surgeons, imaging specialists, anesthesiologists, and cardiac nurses. The team evaluates:
- Severity of aortic stenosis
- Symptoms and impact on quality of life
- Anatomical suitability (size and shape of the aortic annulus, degree and distribution of calcification, coronary ostia height, vascular access)
- Overall health status, frailty, lung and kidney function, and other medical conditions.
Certain situations may favor surgical valve replacement instead, such as very young patients with long life expectancy, significant concomitant coronary artery disease requiring bypass surgery, complex aortic root anatomy, or when other heart procedures (for example, repair of multiple valves) are needed at the same time. Conversely, patients who are extremely frail, have limited life expectancy from noncardiac disease, or have unsuitable vascular anatomy may not be candidates for either TAVR or surgery and may be managed with medical or palliative approaches.
Fact 5: TAVR has a strong success rate
Modern TAVR programs report very high technical and procedural success, with large registries and multicenter studies indicating device success rates typically above 95 percent, meaning the valve is correctly implanted and functions with acceptable gradients and minimal leakage. Thirty-day mortality in contemporary low- and intermediate-risk patients undergoing transfemoral TAVR is often in the range of 1–3 percent, comparable to or lower than surgical aortic valve replacement in similar populations.
TAVR has also shown substantial improvement in symptoms and exercise capacity, with most patients improving by at least one New York Heart Association (NYHA) functional class within months of the procedure. Long-term data up to 5–8 years for some valve types suggest durable hemodynamic performance and survival rates similar to surgical valves in many older patients, though questions about very long-term durability in younger, low-risk patients remain an area of ongoing research.
Fact 6: Not all hospitals perform TAVR
Because TAVR is a complex structural heart procedure, it is only performed in hospitals equipped with advanced cardiac catheterization laboratories or hybrid operating rooms, as well as round-the-clock cardiac surgery backup. These centers must maintain experienced teams in interventional cardiology, cardiac surgery, imaging, anesthesia, intensive care, and specialized nursing to manage pre-procedural assessment, intra-procedural guidance, and post-procedural monitoring.
Many countries require centers to meet specific volume, training, and outcome benchmarks to be designated as TAVR or structural heart centers, and professional societies often recommend minimum annual case volumes to maintain expertise and safety. Patients are generally advised to choose hospitals that participate in national or international registries and quality programs, which helps ensure transparent reporting of outcomes such as mortality, stroke, vascular complications, and pacemaker implantation rates.
Fact 7: TAVR cost and affordability in India and Turkey
The cost of TAVR varies greatly across regions and healthcare systems and is influenced by valve type, hospital category, length of stay, and inclusion of pre- and post-procedure care. In high-income countries such as the United States and Western Europe, total TAVR costs can range from approximately 60,000 to over 200,000 USD when device, hospital charges, physician fees, and follow-up are included.
In leading medical tourism destinations like India and Turkey, TAVR is generally more affordable, with package prices often considerably lower than in the US or Europe, despite being performed in high-end cardiac centers with experienced teams. For international patients, final cost will depend on:
- Choice of city and hospital (corporate tertiary center vs academic/government institution)
- Type and brand of transcatheter valve used
- Complexity of the case (for example, need for additional stenting, ICU stay, or pacemaker placement)
- Nonmedical expenses such as travel, accommodation, interpreters, and medical tourism facilitation services.
Anyone considering TAVR abroad should request a detailed medical estimate that separates device cost, hospital stay, professional fees, and additional tests, and should also confirm what is included in the package (pre-procedure evaluation, medications, follow-up echocardiography, and emergency support).
Key benefits of TAVI patients often experience
Patients who undergo TAVR and are appropriately selected by a heart team may experience:
- Reduced symptoms like breathlessness, fatigue, and chest pain, often within days to weeks.
- Improved exercise capacity and functional status, enabling a more active lifestyle.
- Lower early risk of major complications such as severe bleeding or prolonged ventilation compared with surgery in high- and intermediate-risk groups.
However, like any major cardiac procedure, TAVR carries risks such as stroke, vascular complications, paravalvular leak, need for permanent pacemaker, kidney injury, and, rarely, valve malposition or coronary obstruction, which should be discussed in detail during informed consent. Patients are usually followed regularly with echocardiograms and clinical reviews to monitor valve function and overall heart health after the procedure.
Best Hospitals for Valve Replacement in India
If you or anyone you know is looking for consultation and guidance around TAVI / TAVR, feel free to reach out to us.
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Himang
Author
Himang Gupta is a skilled medical content writer with a Bachelor's degree in Biotechnology and extensive experience crafting engaging and informative blogs. Passionate about simplifying complex medical topics, he ensures his content resonates with readers. When not researching or writing, Himang enjoys scrolling Instagram, cracking jokes, and savoring the flavor of elaichi—his ultimate treat after a productive writing session.
Guneet Bindra
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Guneet Bhatia is the Founder of HOSPIDIO and an accomplished content reviewer with extensive experience in medical content development, instructional design, and blogging. Passionate about creating impactful content, she excels in ensuring accuracy and clarity in every piece. Guneet enjoys engaging in meaningful conversations with people from diverse ethnic and cultural backgrounds, enriching her perspective. When she's not working, she cherishes quality time with her family, enjoys good music, and loves brainstorming innovative ideas with her team.