TAVR in India and UAE — Transcatheter Aortic Valve Replacement | Patient Guide

TAVR candidacy requires: confirmed severe aortic stenosis on echocardiography (aortic valve area below 1 cm², mean gradient above 40 mmHg, peak velocity above 4 m/s); symptoms attributable to the aortic stenosis (angina, syncope, heart failure, or documented exercise limitation); and suitable anatomy on CT angiography — an aortic annulus and access vessel anatomy compatible with TAVR delivery systems.

TAVR is now approved and recommended across the full spectrum of surgical risk:

High-risk surgical patients (STS risk score above 8%, or clinical frailty/comorbidities that make surgical mortality unacceptably high): TAVR is the preferred treatment. The landmark PARTNER 1B trial established TAVR's superiority over medical management alone in inoperable patients; PARTNER 1A demonstrated equivalence to surgery in high-risk patients.

Intermediate-risk patients (STS 4–8%): TAVR shows equivalent or superior outcomes to surgery in the PARTNER 2A and SURTAVI trials, with the added advantage of faster recovery.

Low-risk patients (STS below 4%): The PARTNER 3 and Evolut Low Risk trials both demonstrated non-inferior outcomes for TAVR versus surgical replacement at 2 years, establishing TAVR as a legitimate option for younger, healthier patients — though long-term durability data beyond 5–10 years continues to mature.

Patients NOT suitable for TAVR include those with bicuspid aortic valve anatomy (though TAVR in bicuspid valves is an evolving field at specialised centres), insufficient aortic valve calcification (rare pure aortic regurgitation without stenosis — insufficient calcification to anchor the valve), excessively small or large annular dimensions outside available device sizing ranges, and iliofemoral vessels too small or too tortuous for transfemoral access (though alternative access routes exist — see procedure types).

The vast majority of TAVR procedures — approximately 85–90% — are performed via the transfemoral route: the delivery system is introduced through the femoral artery in the groin, advanced retrogradely up the aorta and through the calcified aortic valve, and deployed under fluoroscopic and echocardiographic guidance.

Pre-procedural CT angiography of the entire aorta and iliofemoral vessels, performed with contrast enhancement, is essential for TAVR planning. It allows precise measurement of the aortic annulus dimensions (to select the correct valve size), assessment of the coronary ostia heights (to plan safe TAVR deployment without coronary obstruction), characterisation of calcium distribution within the aortic valve (to predict paravalvular leak risk), and evaluation of the iliofemoral vessels for femoral access feasibility.

Femoral arterial access is obtained percutaneously under ultrasound guidance; a large-bore sheath (14–20 French, depending on the system) is introduced. A temporary pacing wire is placed in the right ventricle via the femoral vein to allow high-rate pacing during deployment. The delivery system, loaded with the chosen TAVR valve, is advanced over a stiff guide wire through the femoral sheath, up the aorta, across the stenosed native aortic valve, and positioned precisely in the aortic annulus using fluoroscopy and echocardiography.

For balloon-expandable deployment (SAPIEN), high-rate pacing briefly reduces cardiac output; the delivery balloon is inflated, simultaneously expanding the stent frame and deploying the prosthesis. For self-expanding deployment (Evolut), the outer sheath is withdrawn progressively while fluoroscopy confirms positioning; the valve is partially recaptured and repositioned if needed before full release. Immediately after deployment, angiography and echocardiography confirm valve function, assess for paravalvular leakage, and verify coronary flow.

TAVR recovery is remarkably rapid — one of its most compelling advantages over surgical valve replacement. For transfemoral TAVR under conscious sedation, patients are typically sitting up and eating within hours of the procedure. The temporary pacing wire is removed the following morning after overnight ECG monitoring confirms no high-degree heart block. Most patients are ambulating by day one.

The main reason for prolonged hospital stay after TAVR is the need for permanent pacemaker implantation — required in approximately 10–15% of patients (higher with self-expanding valves). Patients who develop new left bundle branch block or high-degree AV block that does not resolve within 24–48 hours require a permanent pacemaker before discharge. This adds 2–3 days to the hospital stay.

Most patients are discharged on day 2 or 3 after uncomplicated transfemoral TAVR. The groin access site heals within 1–2 weeks. Antiplatelet therapy — typically aspirin 100 mg daily, with dual antiplatelet therapy (adding clopidogrel) for 3–6 months in some protocols — is the standard post-TAVR medication. Anticoagulation with warfarin is not required unless the patient has other indications (e.g., atrial fibrillation). Follow-up echocardiography at 1 month and then annually monitors valve function and detects early structural deterioration.