What is TAVR?
Transcatheter Aortic Valve Replacement (TAVR) is a minimally invasive procedure to replace a narrowed or diseased aortic valve that no longer opens properly — a condition called aortic stenosis. Instead of opening the chest and stopping the heart as in traditional open-heart surgery, TAVR delivers a new valve through a thin flexible tube (catheter) inserted through a small incision, most commonly in the groin.
The new valve is crimped onto a delivery system, guided to the heart under X-ray and echocardiographic imaging, positioned precisely within the diseased valve, and expanded — pushing the old valve leaflets aside and immediately restoring normal blood flow. The entire procedure typically takes under two hours, and most patients are walking the next day.
TAVR has undergone one of the most dramatic expansions in cardiovascular medicine history — from a last-resort procedure in inoperable patients (2011) to the preferred approach in most patients with severe aortic stenosis regardless of age or surgical risk (2024 ACC/AHA guidelines).
Who Needs TAVR?
TAVR is indicated for patients with severe symptomatic aortic stenosis — the most common heart valve disease in adults over 65. Symptoms develop when the valve area becomes critically narrowed, restricting blood flow from the heart to the body. Classic symptoms include:
- Chest pain or pressure with exertion (angina)
- Shortness of breath, especially with activity
- Unexplained fainting or near-fainting (syncope)
- Progressive fatigue and reduced exercise tolerance
- Heart failure symptoms — ankle swelling, difficulty lying flat
The 2024 ACC/AHA Valvular Heart Disease guidelines now support TAVR as a reasonable choice for most patients with severe symptomatic AS, with the decision between TAVR and surgical aortic valve replacement (SAVR) made through a shared heart team discussion weighing age, anatomy, valve type, and patient preference.
TAVR vs. SAVR — Which is Right for You?
The decision between TAVR and open-heart surgery (SAVR) is not one-size-fits-all. At NYU Langone's structural heart program, every patient is evaluated by a dedicated heart team including an interventional cardiologist, cardiac surgeon, and imaging specialist. Key considerations include:
- Age: TAVR is preferred for patients over 80; shared decision for ages 65–80; SAVR often preferred under 65 due to valve durability concerns — though this is evolving with NOTION-2 trial data
- Anatomy: Bicuspid aortic valves, heavy LVOT calcium, or unfavorable access may favor surgery
- Frailty: Frail patients benefit most from the minimally invasive approach
- Life expectancy: Valve durability becomes more important in younger, healthier patients
The TAVR Procedure — Step by Step
Before the Procedure
TAVR planning requires a specialized CT scan of the heart, aorta, and access vessels. This CT — interpreted by Dr. Khan using dedicated structural heart software — determines the exact valve size needed, confirms the coronary arteries are at a safe distance, maps the calcium distribution, and identifies the safest access route. Echocardiography confirms severity and provides baseline valve measurements.
During the Procedure
TAVR is performed in a hybrid catheterization laboratory under general anesthesia or conscious sedation. The most common access route is transfemoral — through the femoral artery in the groin via a small incision. Under continuous fluoroscopic (X-ray) and echocardiographic guidance:
- A wire is advanced across the diseased aortic valve into the left ventricle
- The delivery catheter carrying the new valve is tracked over the wire to the valve position
- Precise positioning is confirmed with multiple imaging views
- The new valve is deployed, immediately restoring normal valve function
- Final imaging confirms optimal positioning, minimal paravalvular leak, and normal coronary flow
After the Procedure
Most patients spend one night in the hospital and go home the following day. The access site heals within days. A follow-up echocardiogram at 30 days confirms valve function. Patients typically notice dramatic improvement in symptoms — shortness of breath, fatigue, and chest discomfort — within days to weeks of the procedure.
Key Clinical Trial Evidence
Risks and Considerations
TAVR is a safe procedure in experienced hands, but like all interventions carries risks that are discussed in detail during your consultation:
- Stroke: Less than 2–3% in modern series; cerebral embolic protection devices being studied
- Permanent pacemaker: 5–20% depending on valve platform and anatomy; new conduction abnormalities monitored post-procedure
- Paravalvular leak: Mild leak common; moderate or severe leak associated with worse outcomes — sizing and positioning are critical
- Vascular complications: Access site issues managed with careful ultrasound-guided technique and closure devices
- Valve durability: Structural valve deterioration data out to 10+ years in progress — an important consideration for younger patients
Dr. Khan's Approach to TAVR
Dr. Ali Khan performs TAVR across all major platforms — balloon-expandable (SAPIEN family), self-expanding (Evolut family), and mechanically-expanded systems — allowing device selection tailored to individual anatomy rather than operator preference. His structural heart practice at NYU Langone Health includes the full spectrum of transcatheter valve therapies, with each case reviewed by the multidisciplinary structural heart team before proceeding.
Key elements of his approach include CT-guided annular sizing, IVUS assessment when anatomy is challenging, meticulous access management, and comprehensive post-procedure echocardiographic evaluation before discharge.
Frequently Asked Questions
Am I awake during TAVR?
Most TAVR procedures at NYU Langone are performed under conscious sedation — you are comfortable and relaxed but not under general anesthesia. Some complex cases require general anesthesia, which is determined during pre-procedure planning.
How long does the TAVR valve last?
Current data shows TAVR valves functioning well at 5–10 years in the vast majority of patients. Longer-term durability data is accumulating. For younger patients, valve-in-valve TAVR can be performed if the transcatheter valve ever wears out — meaning the minimally invasive option remains available for the future.
When can I return to normal activities?
Most patients resume light activities within 1–2 weeks. The groin access site heals within 2 weeks. Driving is typically restricted for 2 weeks. Full activity is generally unrestricted at 4 weeks.
Do I need to take blood thinners after TAVR?
Current guidelines recommend aspirin alone or aspirin plus clopidogrel for 3–6 months after TAVR in patients without another indication for anticoagulation. Patients with atrial fibrillation typically continue their oral anticoagulant.