Treatment for severe aortic stenosis (narrowing of the aortic valve) has changed dramatically over the last two decades. In the past, replacing the aortic valve almost always meant open-heart surgery. Today, many patients can be treated with a minimally invasive procedure called transcatheter aortic valve implantation (TAVI or TAVR), which replaces the valve through a small incision, usually in the groin.
Choosing between TAVI and open-heart surgery is no longer a one-size-fits-all decision. The best treatment depends on several factors, including your age, overall health, the structure of your heart, and whether you have any other heart conditions that also need treatment. Understanding how each option works can help you make an informed decision alongside your cardiologist.
Understanding surgical aortic valve replacement (SAVR)
Surgical aortic valve replacement (SAVR) has been the standard treatment for severe aortic stenosis for many years and remains an excellent option for many patients.
During the operation, the surgeon opens the chest, temporarily connects you to a heart-lung machine, removes the damaged valve and replaces it with either a mechanical valve or a biological (tissue) valve. Some surgeons can now do this through a smaller incision, although that is not suitable for all patients and is only done by select surgeons.
For younger patients, surgery is often recommended because of its excellent long-term durability. Mechanical valves can last for many decades, although they require lifelong blood-thinning medication. Tissue valves do not usually require long-term anticoagulation and also have an excellent track record, although they eventually wear out over time.
Surgery is also the preferred option if other heart problems need treating at the same time. For example, if you need coronary artery bypass surgery, repair of another heart valve or treatment of an enlarged aorta, all of these can be carried out during the same operation.
Recovery after surgery is naturally longer because the breastbone needs time to heal. Most patients spend around five to ten days in hospital before continuing their recovery at home. Although recovery takes longer than after TAVI, many patients go on to enjoy excellent symptom relief and long-term outcomes.
The TAVI revolution: a less invasive option
Transcatheter aortic valve implantation (TAVI) has transformed the treatment of aortic stenosis, particularly for older patients and those who may be at higher risk from open-heart surgery.
Rather than opening the chest, your cardiologist inserts a replacement valve through a catheter, usually via a small puncture in the artery at the top of the leg. The new valve is positioned inside the diseased valve and begins working immediately.
Because there is no large chest incision, the procedure places less physical stress on the body. This can make TAVI particularly suitable for people with other medical conditions, such as lung disease, kidney problems, frailty or previous heart surgery.
Careful planning is essential before TAVI. A detailed CT scan allows the heart team to measure the valve accurately, assess the arteries and plan the safest way to perform the procedure. This helps ensure the new valve is positioned correctly and functions as intended.
As technology and experience have improved, TAVI has become a well-established treatment for many patients with severe aortic stenosis. In appropriately selected patients, it provides excellent symptom relief and outstanding clinical outcomes. It is now the standard treatment in Europe for those with severe aortic stenosis over the age of 70 years.
Recovery: days versus weeks
One of the biggest differences between TAVI and open-heart surgery is the recovery time.
Many people who undergo TAVI are sitting out of bed, walking and eating on the same day or the following morning. If recovery is straightforward, they can often return home within one to three days, with select patients even having the procedure as a day-case.
Recovery after surgery is generally longer. Patients usually remain in hospital for around five to ten days before continuing their rehabilitation at home. Because the breastbone needs time to heal, activities such as driving, heavy lifting and strenuous exercise are restricted for several weeks.
Although a quicker recovery is an important advantage of TAVI, it should not be the only factor when choosing treatment. The priority is selecting the procedure that offers the safest treatment and the best long-term result for each individual patient.
How is the decision made?
Choosing between TAVI and surgery involves looking at the whole picture rather than focusing on a single factor.
Your cardiologist will consider your age, general fitness, kidney and lung function, previous heart operations, life expectancy and how active you are. They will also assess whether you are likely to recover well from major surgery.
The anatomy of your heart is equally important. Detailed scans show the size and shape of your aortic valve, the amount of calcium present and whether the arteries are suitable for TAVI. Some patients have anatomy that makes TAVI the ideal option, while others are better served by surgery.
At specialist heart centres, these decisions are usually made by a multidisciplinary Heart Team. This includes interventional cardiologists, cardiac surgeons, imaging specialists, anaesthetists and specialist nurses, who review each case together. By combining their expertise with the latest evidence, they recommend the treatment that offers the greatest benefit and the lowest risk.
Patients are an important part of this decision-making process. Understanding the expected benefits, potential risks, valve durability, recovery time and any future treatment that may be required helps ensure the chosen treatment is the right one for your individual circumstances.
If you have been diagnosed with severe aortic stenosis, a specialist assessment can help determine whether TAVI or open-heart surgery is the most appropriate option. Our team can guide you through the available treatments, explain the benefits and risks of each approach, and help you choose the treatment that is best suited to your heart and your lifestyle.