Aortic stenosis: who is TAVR suitable for?

Are there options when open-heart surgery is high risk?

TAVR is a treatment option for some people with severe aortic stenosis, including some at lower surgical risk. Suitability cannot be judged by age or fear of open-heart surgery alone: the heart team also compares vascular access, valve structure, other conditions and the long-term treatment plan.[2,4] When comparing the two approaches, establish the practical benefits each could offer you and the ongoing burden each may involve.

On 19 October 2026, Shaanxi Provincial People's Hospital reported on a 76-year-old patient repeatedly admitted with chest tightness, breathlessness and episodes of breathlessness at night. The patient had severe aortic stenosis with regurgitation and a left ventricular ejection fraction of 29%. Conventional surgery was assessed as extremely high risk. The team chose transfemoral transcatheter valve replacement, using extracorporeal membrane oxygenation (ECMO) for circulatory support.[1]

Transcatheter aortic valve replacement is abbreviated to TAVR and is also called TAVI. A new valve is delivered through a catheter to the heart and placed inside the narrowed valve. Once expanded, it takes over the task of controlling blood flow; the old valve is usually left in place. This can be an option for some people with severe aortic stenosis, including some unable to tolerate open-heart surgery.[2]

Ultrasound during the Shaanxi procedure showed that the new valve was functioning well. The report did not provide information on symptoms after discharge, recovery of heart function or long-term follow-up. ECMO was part of this patient's support plan; a similar ejection fraction in another patient would not, by itself, establish a need for the same arrangement.[1]

Assess the heart and the access vessels separately

High risk from open-heart surgery does not automatically mean a catheter-based approach is feasible. The Shaanxi patient also had a sharply angled aortic arch and calcified major blood vessels with thrombus. The team needed to assess both how to reach the valve and how to maintain circulation during the procedure.[1]

Assessment generally uses echocardiography to examine the heart and valves, CT to show the heart and blood vessels in detail, and coronary artery testing when needed.[3] The results inform different decisions: where the catheter can enter, whether the existing valve can accommodate a new one, and whether coronary disease also needs treatment.[4,7] When comparing plans from hospitals in China, ask the team to identify the specific imaging findings that support or rule against the proposed access route.

The European Society of Cardiology's official explanation of its 2025 valve guidelines considers vascular access and valve anatomy alongside age, other conditions and life expectancy. Surgery retains an important role in younger people at lower surgical risk and in those with a bicuspid aortic valve.[4] These factors help explain the comparison; the receiving heart team must still assess the individual plan.

Which circumstances can change the choice?

The American College of Cardiology's clinical review summary identifies several circumstances that can influence the choice between the two approaches:[7]

Previous coronary artery bypass surgery: another operation may involve bypass grafts that are still functioning. This can add a reason to discuss TAVR.

Severe peripheral artery disease, such as disease in the leg arteries, or marked calcification below the valve: catheter-based treatment itself may be more difficult. These findings cannot be disregarded because open-heart surgery is high risk.

A bicuspid aortic valve: leaflet shape and calcification may be asymmetric and require closer assessment. Some people at high surgical risk may still discuss TAVR, but the team must judge whether their anatomy is suitable.[9]

Other conditions best addressed surgically: severe coronary disease requiring bypass surgery, or an aneurysm of the aortic root or ascending aorta, may make a combined surgical approach more worth considering.

These factors can shift the comparison; they are not a scoring checklist for patients to decide their own eligibility. The Shaanxi case shows that surgical risk and catheter-based procedural difficulty can both be high. The hospital needs to explain its reasoning and how it plans to manage serious complications if they occur.[1,5]

What matters beyond the size of the incision?

Transfemoral TAVR does not require opening the breastbone, but blood vessel injury, bleeding, stroke or leakage around or through the new valve can still occur. Some patients develop cardiac conduction problems and need a permanent pacemaker. Serious complications, including death, are also possible.[5] Avoiding open-heart surgery alone does not establish that TAVR is safer for a particular person.

Medicines can relieve some symptoms but cannot repair the narrowed valve. Surgical replacement remains another treatment approach. Balloon dilation may be used in particular circumstances, but its relief is often temporary.[5] If the team recommends one option, ask why the alternatives are less suitable rather than comparing hospital stays alone.

Surgical valve replacement does not always require a long incision down the chest. Some people may be considered for surgery through smaller chest incisions, subject to assessment.[8] Establish whether the proposed procedure is transcatheter treatment or minimally invasive surgical replacement: the routes to the heart and the treatment of the original valve differ.

How long will the replacement valve last?

TAVR uses a biological tissue valve. Surgical replacement can involve a mechanical valve or a tissue valve.[6,8] Mechanical valves are generally more durable but require lifelong anticoagulation. Tissue valves deteriorate, and some patients need another intervention later.[8] For a younger person expecting to use the valve for many years, this distinction may matter more than the initial hospital stay.

Do not assume that placing another valve inside it later will necessarily be possible. The feasibility of repeat TAVR and access for future coronary artery investigations and treatment should be considered before the first replacement.[7] Durability belongs in an individual long-term plan; a general description of tissue-valve lifespan cannot determine your own replacement date.[4,7]

A tissue valve also does not guarantee that no medicines to prevent blood clots will be needed after treatment. The medicines and duration depend on individual circumstances.[6] If concern about bleeding from anticoagulation influences your valve choice, ask the team to explain the actual postoperative medication plan.

Arrange continuing care before travelling to China

Existing echocardiograms, CT or angiography records, and records of recent admissions for heart failure can be organised using the Medical records and imaging preparation guide for the team you hope to see. Submit existing records first; the hospital decides which tests need to be added.

Regular follow-up and imaging are still needed after treatment to assess how the new valve is working. Follow the treatment team's instructions on which medicines to take and for how long.[6] During assessment in China, also discuss which cardiology service will continue care after you return home and which records you will need to take. An intraoperative result in a hospital report cannot replace an individual assessment for discharge or return travel.

If you currently have chest pain, sudden severe breathlessness or fainting, seek emergency medical help locally rather than waiting for an appointment in China or a remote assessment.[6]