Twenty years ago, severe symptomatic aortic stenosis had only one effective treatment: open-heart surgery to replace the diseased valve. For many older Australians with significant comorbidities, that surgery was either too risky or too daunting, and treatment was declined. Transcatheter aortic valve implantation, or TAVI, has changed that calculus.

What TAVI is

TAVI is a procedure to replace a stenotic aortic valve without opening the chest or stopping the heart. A new biological valve, mounted on a stent frame, is collapsed to about the size of a pencil and threaded through a leg artery up to the heart. There it is deployed inside the existing diseased valve, where it expands and immediately starts to function.

The procedure typically takes one to two hours. Most patients are awake under conscious sedation, walking the next day, and home within 48 hours.

Who it is for

Initial trials of TAVI focused on patients who could not safely undergo conventional surgery. Subsequent studies extended TAVI to high-risk, intermediate-risk, and now low-risk patients. The choice between TAVI and surgical aortic valve replacement is made by a Heart Team — typically an interventional cardiologist, a cardiothoracic surgeon, and imaging specialists — and depends on age, anatomy, the access vessels, comorbidities, and informed patient preference.

What TAVI is not

It is important to be honest about TAVI's limits. The trade-offs are real:

  • The risk of needing a permanent pacemaker after TAVI is higher than after surgery
  • Stroke risk is comparable but not zero
  • Long-term durability of transcatheter valves is still being characterised, particularly in younger patients with longer expected lifespans
  • Some anatomies are unsuitable for TAVI and surgery remains the better option

Why timing matters

Severe symptomatic aortic stenosis has a poor natural history without treatment. Symptoms tend to be attributed to ageing — slowing down, getting tired on the stairs, dizziness — and review is often delayed. If you or a family member has been told you have a heart murmur and have noticed any of these changes, it is worth asking your GP for an echocardiogram and, if severe, a referral for Heart Team review.