What is Transcatheter Aortic Valve Replacement (TAVR)?

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Last updated: April 5, 2025 • View editorial policy

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From the Guidelines

TAVR is recommended for patients with severe symptomatic aortic stenosis who are at high risk for traditional open-heart surgery or have a prohibitive surgical risk, as it improves survival and reduces symptoms 1.

Patient Selection

When considering TAVR, patient selection is crucial. The procedure is recommended for patients who meet an indication for aortic valve replacement (AVR) and have a prohibitive risk for surgical AVR, with a predicted post-TAVR survival greater than 12 months 1. Patients with severe symptomatic aortic stenosis who are unable to undergo surgical AVR due to a prohibitive surgical risk and have an expected survival of >1 year after intervention are ideal candidates for TAVR 1.

Procedure and Outcomes

TAVR is a minimally invasive procedure where a new valve is inserted through a catheter, typically via the femoral artery in the groin, and positioned inside the diseased native valve. The new valve expands and pushes the old valve leaflets aside, immediately improving blood flow. Studies have demonstrated the feasibility, excellent hemodynamic results, and favorable outcomes of the procedure, with a lower rate of all-cause death and repeat hospitalization compared to standard medical therapy 1.

Risks and Complications

While TAVR has revolutionized aortic valve replacement, it is not without risks and complications. The rate of major stroke at 30 days is higher with TAVR, and major vascular complications can occur 1. Therefore, the decision to undergo TAVR should be made after discussion with the patient about the expected benefits and possible complications of TAVR and surgical AVR.

Post-Procedure Care

After TAVR, patients are usually prescribed blood thinners such as aspirin (81mg daily) indefinitely and clopidogrel (75mg daily) for 1-6 months to prevent blood clots from forming on the new valve. Patients typically stay in the hospital for 1-3 days following the procedure, significantly shorter than the recovery time for open-heart surgery.

Recommendations

The choice of TAVR versus surgical AVR depends on patient-specific procedural risks, values, and preferences. For patients with severe symptomatic aortic stenosis who are at intermediate risk, TAVR is a reasonable alternative to surgical AVR, depending on patient-specific procedural risks, values, and preferences 1. However, TAVR is not recommended in patients in whom existing comorbidities would preclude the expected benefit from correction of aortic stenosis 1.

From the Research

TAVR Overview

  • TAVR (Transcatheter Aortic Valve Replacement) is a minimally invasive procedure for treating aortic stenosis, a common valvular heart disease, especially among the elderly 2.
  • The procedure has been approved for high-risk and inoperable patients with severe aortic stenosis and is associated with excellent surgical outcomes 2.
  • TAVR has become the preferred treatment option for appropriate patients with symptomatic severe aortic stenosis, with expanding indications to include bicuspid aortic valve, small aortic annuli, low-flow, low-gradient AS, and younger patients 3.

Comparison with SAVR

  • Surgical aortic valve replacement (SAVR) is the most effective therapy for aortic stenosis, but its indication can be difficult, and it may be impossible for high operative risk patients 2.
  • TAVR has shown no significant differences from SAVR in all-cause mortality at two years and up to 5 years in high-risk surgically operable patients 4.
  • For asymptomatic severe aortic stenosis, early TAVR has been shown to be superior to clinical surveillance in reducing the incidence of death, stroke, or unplanned hospitalization for cardiovascular causes 5.

Patient Selection and Outcomes

  • The selection of TAVR or SAVR should consider patient characteristics, comorbidities, anatomical considerations, and overall life expectancy 6.
  • TAVR is a viable life-extending treatment option for patients with severe aortic stenosis who are at high surgical risk or inoperable 4.
  • The choice between TAVR and SAVR requires personalized decision-making and a multidisciplinary approach involving an experienced heart team 6.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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