TAVI (keyhole aortic valve replacement) (Transcatheter aortic valve implantation (TAVI))
A catheter-based procedure that fits a new aortic valve through a blood vessel, usually in the groin, without open-heart surgery — mainly for people for whom surgery is higher risk.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- TAVI fits a new aortic valve through a blood vessel, usually in the groin, without open-heart surgery.
- It is mainly for people for whom open surgery is higher risk, though it is now used more widely; a heart team decides who it suits.
- Recovery is usually quicker than surgery, often with a short hospital stay, but it still carries real risks such as stroke, the need for a pacemaker and bleeding.
- How long a TAVI valve lasts in younger people is still being studied, which matters when choosing between TAVI and surgery.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your surgeon will give you advice for your situation.
Replaces a narrowed aortic valve without open-heart surgery
Open surgery would give you a better or more durable result, for example in some younger, lower-risk patients.
You are monitored closely, especially your heart rhythm and the groin access site. You usually need to keep the leg still for a while to protect the...
Close heart-rhythm monitoring in the first days, with a clear plan if a pacemaker is needed.
You are monitored closely, especially your heart rhythm and the groin access site. You usually need to keep the...
Most people get up and about and go home within 1–3 days, once the heart rhythm and access site are stable.
Take it easy and avoid heavy lifting and straining while the access site heals. Watch for bruising, swelling or...
Energy usually improves and many people return to normal activities. Cardiac rehabilitation can help you rebuild...
What is TAVI?
TAVI (transcatheter aortic valve implantation) is a way of replacing a narrowed aortic valve without open-heart surgery. The aortic valve is the one-way door between the heart's main pumping chamber and the body's main artery. When it narrows (aortic stenosis), the heart has to work harder, causing breathlessness, chest tightness, dizziness or blackouts.
Instead of opening the chest, a thin tube (catheter) is passed through a blood vessel, usually in the groin, up to the heart. A new valve, mounted on a frame, is positioned inside the old valve and opened up, pushing the old valve aside and taking over its job.
TAVI was developed first for people who were too high-risk or unsuitable for open surgery, and it is now used for a wider group, including some lower-risk and older patients. It is not automatically better than surgery for everyone — the right choice depends on your age, anatomy and overall health, and should be decided by a specialist heart team.
TAVI is less invasive than surgery, but it is still a serious heart procedure with real risks, including stroke, the need for a pacemaker and bleeding.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
TAVI vs open aortic valve surgery (SAVR)
| Point | TAVI | Open surgery |
|---|---|---|
| Approach | Catheter, usually via the groin | Open chest, breastbone divided |
| Recovery | Usually quicker; short stay | About a week in hospital, 2–3 months |
| Pacemaker need | Higher chance | Lower chance |
| Valve leak around the edge | More common | Less common |
| Long-term durability | Good early data; less long-term data in the young | Long track record |
TAVI is less invasive, but pacemaker need and small leaks around the valve are more common than with surgery, and long-term durability in younger people is still being studied. A heart team weighs all of this with you.
Preparing for your procedure
- Be assessed by a specialist heart team (cardiologists, surgeons, imaging and anaesthetic experts) who decide if TAVI suits you better than surgery.
- Expect detailed scans, especially a CT scan, to size the valve and check your blood vessels and access route.
- Expect an echocardiogram, ECG and blood tests, and a check of your kidney function before contrast dye is used.
- Tell the team about all medicines and supplements; blood thinners and diabetes medicines may need adjusting.
- Have a dental check, as treating dental infection first lowers the risk of a valve infection.
- Arrange someone to take you home and help for the first days, as you should not drive immediately.
- Ask whether you will have local anaesthetic with sedation or a general anaesthetic.
What happens
TAVI is usually done in a specialist room (a catheter or hybrid lab) by a heart team. Many people have local anaesthetic with sedation, so they are relaxed but not fully asleep; some have a general anaesthetic.
A thin tube is passed through a blood vessel, usually in the groin, up to the heart, using X-ray and ultrasound guidance. The new valve is positioned inside the old aortic valve and opened up, immediately taking over the job of controlling blood flow. The team checks the valve is working well before removing the tube and closing the small access point.
The procedure often takes around one to two hours. Afterwards you are monitored closely, sometimes in a high-dependency area, particularly to watch your heart rhythm and the groin access site. Many people go home within a few days.
Is this procedure right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Open surgery would give you a better or more durable result, for example in some younger, lower-risk patients.
- Your blood vessels or valve anatomy are unsuitable for safely delivering or anchoring the valve.
- Your life expectancy or general health is such that the procedure is unlikely to help, so a comfort-focused plan may be kinder.
- Active infection or another condition makes the procedure unsafe right now.
Delay or rearrange if…
- You have an active infection, including dental infection, that should be treated first.
- Important assessments are missing, such as the CT scan needed to size the valve and check access.
- Your kidney function needs review before contrast dye is used.
- Blood thinners or other medicines need safe adjustment beforehand.
- Your symptoms or overall condition are unstable and need stabilising first.
Alternatives to discuss
- Open or minimally invasive surgical aortic valve replacement for suitable patients.
- Careful monitoring if the narrowing is not yet severe or not causing symptoms.
- Balloon valvuloplasty as a temporary measure in selected cases.
- Medicines to manage symptoms, though they do not fix the valve.
- A comfort-focused (palliative) approach if a procedure is not in your best interests, discussed honestly.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Comfort, sedation or contrast choices
If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.
Benefits
- Replaces a narrowed aortic valve without open-heart surgery
- Often suitable for people who are too high-risk or frail for surgery
- Usually a quicker recovery and shorter hospital stay than open surgery
- Can be done with local anaesthetic and sedation rather than a general anaesthetic
- Often improves breathlessness, dizziness and energy as you recover
- The new valve works immediately
Risks & complications
- Bruising, bleeding or swelling where the catheter went in (usually the groin)
- A short period of feeling tired or washed out afterwards
- Temporary confusion or disorientation, particularly in older or frailer people
- An irregular or changed heartbeat that needs monitoring
- A heart-rhythm problem needing a permanent pacemaker
- A leak of blood around the edge of the new valve (paravalvular leak)
- Damage to the blood vessel used for access, sometimes needing repair or transfusion
- Kidney strain from the contrast dye, more likely if kidneys were already impaired
- Stroke during or soon after the procedure
- Serious bleeding, or the valve not sitting correctly and needing further treatment
- Infection of the new valve (endocarditis)
- Death — uncommon, but a real risk, especially in frailer, higher-risk patients
The main risks to weigh are stroke, the need for a permanent pacemaker, a leak around the valve and bleeding or vessel damage at the access site. The chance of needing a pacemaker, and of a small leak, is generally higher than with open surgery. Ask the heart team for your own estimated risks, why TAVI rather than surgery is recommended for you, and how long a TAVI valve is expected to last at your age.
Published figures to discuss
Risks after TAVI depend on your age, frailty, anatomy and the valve type used, so a single figure can mislead. Compared with open surgery, the need for a permanent pacemaker and a small leak around the valve are generally more common, while recovery is usually quicker. The ranges below come from trials and NICE evidence; your personal risks should be estimated by the heart team. Long-term durability data, especially in younger people, is still maturing.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Need for a permanent pacemaker | Commonly around 1 in 10 or so, but markedly higher with some self-expanding valves | NICE evidence shows rates varying widely by valve type (from roughly 7–10% up to about a third in some self-expanding-valve trials); generally higher than after surgery. | NICE — TAVI for aortic stenosis: safetynice.org.ukPublished figure |
| Stroke around the procedure | A small percentage, broadly similar to surgery in the trials | In NICE-reviewed trials, 30-day stroke was in the region of a few percent and not consistently different from surgery. | NICE — TAVI for aortic stenosis: safetynice.org.ukSource-linked context |
| Leak around the valve (paravalvular regurgitation) | More common than after open surgery | Mild leaks are more frequent with TAVI; the team checks for this during the procedure. | Guide sourcesClinical context |
| Death around the procedure (30 days) | Reported around 3–5% in higher-risk groups in trials, lower in lower-risk patients | Depends heavily on baseline risk; ask the heart team for your individual estimate. | TAVI vs SAVR in low-risk patients — PMCpmc.ncbi.nlm.nih.govPublished figure |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
Recovery from TAVI is usually quicker than after open surgery, because there is no chest wound or breastbone to heal. Many people go home within a few days, though it can still take several weeks to feel fully back to normal.
- Bruising, tenderness or a small lump where the catheter went in
- Feeling tired or a little washed out for a week or two
- Gradually noticing less breathlessness as you recover
- Mild aches and a need to take things gently at first
- Being monitored for heart-rhythm changes in the early days
Aftercare
- Take all medicines as prescribed, including any blood thinners or antiplatelets your team advises.
- Look after the groin (or other access) site and watch for bruising, swelling, bleeding or pain.
- Avoid heavy lifting and straining for a week or two while the access site heals.
- Build up activity gradually and ask about cardiac rehabilitation.
- Tell any dentist or doctor you have a replacement valve, as you may need antibiotics for some procedures.
- Attend follow-up appointments, including heart-rhythm and valve checks.
- Do not drive until your team advises it is safe, and check the current driving rules — these are set by the DVLA in England, Scotland and Wales, and by the DVA in Northern Ireland.
- Someone to take you home and help for the first days
- A supply of your medicines and a clear list, including any blood thinners
- Loose, comfortable clothing that does not press on the groin site
- Knowledge of how to look after the access site and what to watch for
- An alert card or note that you have a replacement heart valve
- Cardiac rehabilitation or follow-up appointment noted
- Clinic and out-of-hours contact numbers saved
Scars and how they heal
TAVI does not involve a chest wound. There is usually only a small puncture or short cut where the catheter entered the blood vessel, most often in the groin, which leaves a small mark and may bruise. If an alternative access route is used, there may be a small scar there instead.
⚠ Get urgent help if…
- Signs of stroke — face drooping, arm weakness or slurred speech — call 999 immediately
- Fainting, blackouts or a very slow, fast or irregular heartbeat with dizziness
- Sudden or worsening breathlessness, or chest pain
- Bleeding, a rapidly swelling lump, severe pain or coldness in the leg with the access site
- Fever or feeling generally unwell, which can signal infection
- A cold, pale or numb leg or foot on the side of the access site
- Increasing redness, heat or discharge at the access site
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your surgeon gives you.
Results & realistic expectations
A successful TAVI relieves the narrowing of the aortic valve, so the heart no longer has to strain against it. The new valve works immediately, and many people notice less breathlessness, dizziness and tiredness as they recover. In people for whom surgery would be high risk, TAVI can improve both how they feel and how long they live.
TAVI does not make the heart young again, and a small leak around the valve or a change in heart rhythm needing a pacemaker can occur. How long a TAVI valve lasts, especially in younger people, is still being studied, which is an important part of the discussion when choosing between TAVI and surgery.
Early and medium-term results for TAVI valves are reassuring, and for most people the valve is still working well several years after the procedure. However, there is less very long-term data than for surgical valves, which matters most for younger patients who may live many years with the valve. If a TAVI valve wears out, it can sometimes be treated with another valve placed inside it (valve-in-valve). Your heart team will explain what is known for your age and valve type.
Related tests, treatments or support
TAVI treats the aortic valve only. If you also have significant narrowing in the heart's arteries, the team may treat this separately, for example with stents, rather than in the same setting. Where you have more than one heart problem, the heart team will plan the safest order and combination of treatments with you.
Follow-up & long-term care
You will be monitored closely in the first day or two, particularly for heart-rhythm changes that might need a pacemaker. After you go home you will have follow-up appointments, usually including an echocardiogram to check the valve and a review of your heart rhythm and medicines, often with the option of cardiac rehabilitation.
- Taking any prescribed blood thinners or antiplatelets exactly as advised
- Good dental care and telling clinicians you have a replacement valve, to reduce infection risk
- Periodic echocardiograms to check the valve over time
- Monitoring for heart-rhythm changes, including whether a pacemaker is needed
- Managing blood pressure and other heart risk factors
- Prompt review if breathlessness, dizziness or fainting returns
Repeat, follow-on and what comes next
- Some people need a permanent pacemaker after TAVI because of a change in the heart's electrical conduction.
- A significant leak around the valve may occasionally need further treatment.
- If a TAVI valve wears out over time, another valve can sometimes be placed inside it (valve-in-valve).
- Long-term durability, especially in younger patients, is still being studied.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- Close heart-rhythm monitoring in the first days, with a clear plan if a pacemaker is needed.
- A named contact and clear out-of-hours route for stroke symptoms, fainting, breathing or access-site problems.
- Planned echocardiogram follow-up to check the valve, including for any leak.
- Advice on dental care and antibiotic cover to reduce valve-infection risk.
- Cardiac rehabilitation and clear medicine instructions, including any blood thinners.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- The operator's and team's fees, and the specialist heart-team assessment
- The valve device used (different valve types have different costs)
- Catheter-lab or hybrid-theatre time, and whether sedation or general anaesthetic is used
- Detailed pre-procedure imaging, especially CT, and contrast
- Length of stay and level of monitoring needed afterwards
- Whether a pacemaker is needed, and any treatment of the access site
- Cardiac rehabilitation and follow-up echocardiograms
- The operator's and heart-team fees
- The valve (device) cost and which type is included
- Catheter-lab/theatre and anaesthetic or sedation charges
- Pre-procedure imaging (including CT) and assessments
- Expected length of stay and monitoring, and the cost of extra days
- Follow-up appointments, echocardiograms and heart-rhythm monitoring
- What happens, and who pays, if you need a pacemaker, vessel repair or readmission
On the NHS? TAVI is available on the NHS for suitable patients selected by a specialist heart team; private care may be considered for choice or timing, but suitability is still decided clinically.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- No clear explanation of why TAVI is chosen over surgery, or vice versa, for you.
- The higher chance of needing a pacemaker, and of a small valve leak, not being spelled out.
- Uncertainty about long-term valve durability not discussed, particularly for younger patients.
- Risks at the access site (bleeding, vessel damage) and kidney effects of contrast not explained.
- No written aftercare and warning-signs plan, including heart-rhythm symptoms, before discharge.
Marketing red flags
- Promoting TAVI as 'better than surgery for everyone' regardless of age or anatomy.
- Describing it as a quick or without risks fix, without mentioning stroke, pacemaker or leak.
- Glossing over uncertainty about how long the valve lasts in younger people.
- Skipping the role of a specialist heart team in deciding suitability.
Choosing a specialist safely
- Check the surgeon is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the surgeon who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good surgeon will welcome every one of these.
- Why do you recommend TAVI rather than open surgery for me?
- What is my personal estimated risk of stroke, pacemaker and bleeding?
- Which access route and valve type will you use, and why?
- How long is this valve expected to last at my age, and what happens if it wears out?
- Will I have local anaesthetic with sedation or a general anaesthetic?
- How will my heart rhythm be monitored afterwards, and for how long?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the surgeon who carries out my procedure, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this procedure not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Is TAVI better than open surgery?
Will I be awake during TAVI?
How likely am I to need a pacemaker?
How long will the new valve last?
How long is the recovery?
Is TAVI available on the NHS?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: British Heart Foundation — TAVI NICE — TAVI for aortic stenosis: safety NHS England — TAVI and SAVR for severe aortic stenosis (position statement) NICE NG208 — Heart valve disease in adults TAVI vs SAVR in low-risk patients — PMC DVLA — assessing fitness to drive DVA Northern Ireland — telling DVA about a medical condition
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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