What is the TAVR/TAVI Procedure? Steps, Success Rate, Risks and Cost in India

If your doctor has told you that your aortic valve is severely narrowed, you probably have many questions: What is TAVR? Is it safe? How long is recovery? What does it cost? This guide answers these questions in simple language.

What is TAVR / TAVI?

Transcatheter Aortic Valve Replacement (TAVR), also called Transcatheter Aortic Valve Implantation (TAVI), is a minimally invasive procedure to replace a diseased aortic valve with a new one. It is mainly used for severe aortic stenosis, a condition in which the aortic valve becomes narrow and blocks blood flow from the heart to the rest of the body.

Instead of opening the chest, a thin tube (catheter) is guided through the blood vessels to the heart, most often through an artery in the groin. The new valve, made of tissue leaflets mounted on a metal frame, is expanded inside the old valve and starts working immediately, pushing the diseased leaflets aside.

Who needs TAVR?

TAVR is advised for patients with severe aortic stenosis, especially older patients or those at higher risk from open-heart surgery because of age or other health problems. Compared with traditional surgery it usually means a shorter hospital stay and a quicker recovery. The final choice is made by a heart team after tests such as echocardiography and CT scan. You can read more about the condition in our guide to aortic stenosis symptoms, causes and treatment, and compare options in TAVR vs open heart valve surgery.

TAVR procedure: step by step

• Preparation: the access area, usually the groin, is cleaned and the patient is given either general anaesthesia or conscious sedation. Heart rhythm, blood pressure and oxygen levels are monitored throughout.
• Access: a small puncture or cut is made in the artery and a hollow tube (sheath) is placed to allow the catheters to pass.
• Guidewire placement: a thin guidewire is advanced through the blood vessels up to the heart under X-ray (fluoroscopy) guidance.
• Catheter insertion: a catheter carrying the folded replacement valve is moved over the guidewire to the diseased aortic valve.
• Valve deployment: the new valve is opened inside the old valve. It may be balloon-expandable (opened with a balloon) or self-expanding (opens on its own when released).
• Checking the result: imaging such as X-ray and echocardiography confirms that the valve is well positioned and working properly.
• Closure and recovery: the catheters are removed, the access site is closed with stitches or a closure device, and the patient is observed closely before moving to the ward.

Access routes

The most common route is through the artery in the groin (transfemoral). If the leg arteries are not suitable, other routes such as the collar bone (subclavian or axillary) artery, the neck artery or a small cut in the chest may be used. The wrist artery is sometimes used for additional access during the procedure. The best route is chosen after a CT scan.

Recovery after TAVR

Most patients start walking within a day and go home in a few days if there are no complications. For a day-by-day guide, read recovery after TAVR: what to expect.

TAVR success rate

The success rate of TAVR is high in experienced centres, but it depends on patient selection, the operator's experience and other health conditions. In general:

• In most patients the diseased valve is successfully replaced and blood flow improves
• Many patients notice better breathing, less tiredness and less chest discomfort
• In suitable patients, results are comparable to surgical valve replacement, with a shorter stay and faster recovery
• Long-term studies show durable benefit, and regular follow-up helps keep it that way

Every patient is different, and no doctor can promise a guaranteed outcome.

Life expectancy after TAVR

Severe symptomatic aortic stenosis can shorten life if left untreated. After TAVR, many patients enjoy better symptoms, activity levels and quality of life, and survival is comparable to surgery in appropriately selected patients. Actual outcome depends on age, heart function, kidney function and other illnesses, so regular follow-up visits, scans and medicines are important.

Risks and possible complications of TAVR

• Stroke: small particles can travel to the brain during or after the procedure
• Vascular injury and bleeding: at the puncture site or inside the body, more likely with blood thinners
• Valve position problems: the valve may sit slightly off or move, sometimes needing a second step to correct
• Rhythm problems: irregular or slow heartbeat, which sometimes needs a pacemaker
• Valve leak or narrowing: leakage around the valve, or rarely clot on the valve
• Kidney injury: mainly in patients who already have kidney disease
• Infection: at the access site or, rarely, in the blood or valve

Your doctor will explain your personal risk before the procedure.

TAVR cost in India

The cost of TAVR in India is approximately Rs 6 lakh to Rs 11 lakh, but it varies with the hospital, the city, the type of valve, your medical condition and any other services required. Please treat this as a rough range and contact the hospital for an accurate estimate, including what is covered in the package. Also plan for travel, stay and follow-up care.

TAVR specialist in Jaipur: Dr. Prashant Dwivedi

Dr. Prashant Dwivedi is the in-charge of the TAVR and Structural Heart Disease Programme at the Eternal Heart Care Centre and Research, Jaipur. He completed fellowships in Interventional Cardiology and Structural Heart Disease at Mount Sinai Hospital, New York, and has dedicated training in TAVR, MitraClip, TriClip and TMVR. Patients from Jaipur and across Rajasthan consult him for careful evaluation, personalised planning and complete support through their TAVR journey. See also what to look for in a TAVI expert in Jaipur.

This article is for general information and does not replace personal medical advice. Please consult a cardiologist to know whether TAVR is right for you.