Transcatheter Aortic Valve Implantation (TAVI)

For people with the severe disease of the aortic valve, surgery to replace the valve is often the only treatment that offers substantial relief. However, aortic valve surgery exposes patients to significant risks, and sometimes those risks prohibit surgery. Transcatheter aortic valve implantation (TAVI) was developed in the attempt to devise a less invasive, less risky approach to replacing diseased aortic valves.

In TAVI, an artificial aortic valve is implanted by means of a sophisticated catheterization procedure. While TAVI is still considered a new procedure, it is approved in the United States and the European Union for the treatment of certain high-risk patients with severe aortic stenosis. In Europe, it is also approved for treating some people with severe aortic regurgitation.

Heart surgeon during a heart operation
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About Aortic Valve Disease

In aortic stenosis, the aortic valve becomes partially obstructed, which forces the heart to work much harder to pump blood to the body. In aortic regurgitation, the aortic valve fails to close completely, allowing blood to flow back into the heart when the valve is supposed to be closed. Eventually, either of these aortic valve conditions can progress to heart failure, causing edema (swelling), dyspnea, and (often) death.

While symptoms of aortic valve disease can be managed for a time using medical therapy for heart failure, no medicine can relieve a mechanical problem with the aortic valve. The only really effective treatment is to surgically replace the diseased aortic valve with an artificial valve.

Unfortunately, the standard method of aortic valve replacement requires a major open-heart surgical procedure, and, especially in the elderly patients who most typically develop aortic stenosis, it is a procedure that carries significant risk.

The TAVI procedure has been developed as a potentially lower-risk approach to replacing the aortic valve.

How Are TAVI Devices Inserted?

Several TAVI systems have been developed by various medical device companies, and while each device has its unique features, all of them work similarly. The artificial valve is attached to a collapsed wire frame, which is In turn attached to a catheter. The catheter is inserted into a blood vessel (usually, the femoral artery near the groin), and is advanced to the area of the aortic valve. When in position, the wire frame is expanded by blowing up a balloon. This allows the artificial valve to open up and attach itself, and to begin functioning.

What Are The Results With TAVI?

Early studies with TAVI were limited to patients with severe aortic stenosis who were deemed too sick to have the open-heart surgery necessary for “standard” aortic valve replacement. In these very sick patients, those who were randomized to receive TAVI had a significantly reduced mortality rate and significantly improved symptoms after one year, compared to those who received medical therapy alone.

However, patients randomized to TAVI had a 5% incidence of major stroke, compared to only 1% in medically treated patients. TAVI-related strokes are embolic strokes.

A later study compared TAVI to standard aortic valve replacement in 690 patients with severe aortic stenosis. The mortality rates, stroke rates, and symptom improvement were similar at one year in both groups.

Those treated with TAVI had more major complications to the blood vessels, and those treated with open-heart surgery had more bleeding complications and more post-operative atrial fibrillation.


While TAVI is much less invasive than open heart surgery, it still carries significant risks. The two most frequent and serious risks are serious damage to the major blood vessels, and stroke. Both of these complications are due to often-unavoidable trauma caused by inserting the sizable and relatively rigid valve mechanism into an aorta that is often diseased. As a result of such complications, the risk of death with TAVI is around 6% within 30 days of the procedure.

Recent evidence suggests there is a steep “learning curve” associated with performing the TAVI procedure. In particular, the risk of serious complications seems to be highest during the first 30 TAVI procedures a doctor performs.

The companies that are developing TAVI devices continue to work on improving the technology, in an attempt to reduce the risks associated with their use. For the present, however, the risks remain substantial.

The Current State of TAVI

At its present state of development, TAVI is reserved for people who have significant aortic stenosis (or in some regions, aortic regurgitation), in whom the risk of standard aortic valve replacement surgery is deemed to be extremely high.

In particular, current guidelines recommend TAVI in patients whose estimated risk of surgical death or serious irreversible complications is 50% or higher. In people whose surgical risk is considered low, then standard valve replacement surgery is recommended. In those whose surgical risk is intermediate, the decision regarding surgery or TAVI is made on a case by case basis.

If TAVI is recommended for either you or a loved one, you should make sure the procedure is going to be performed by a doctor who has had substantial experience with this technique.

A Word From Verywell

TAVI is a relatively new and still developing alternative to open heart surgery in people with severe aortic valve disease. Today, TAVI is giving real hope to people whose surgical risk would otherwise be prohibitive.

In the future, it is likely that TAVI will become an approved alternative to open-heart surgery for at least some patients with significant aortic stenosis who are not yet “too sick” for standard valve replacement surgery. But given the complications that, so far, are associated with TAVI, we are not there yet.

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