TAVI Outcomes in the Elderly

For an older person with severe aortic stenosis, the thought of undergoing open-heart surgery can be daunting. Age often comes with other health concerns such as diabetes, kidney disease, lung problems or reduced physical strength, all of which can make conventional surgery more demanding.

Transcatheter Aortic Valve Implantation (TAVI), also called Transcatheter Aortic Valve Replacement (TAVR), has changed the treatment landscape for many of these patients. The procedure replaces a diseased aortic valve through a catheter, usually introduced through an artery in the groin, without opening the chest.

More importantly, current evidence and guidelines support TAVI as an important treatment option for appropriately selected older adults with severe aortic stenosis. The 2025 ESC/EACTS guidelines now recommend TAVI as the primary treatment for anatomically suitable patients aged 70 years or older with a tricuspid aortic valve, when transfemoral access is feasible.

Why Does Aortic Stenosis Become More Important With Age?

The aortic valve sits between the left ventricle and the aorta. With aortic stenosis, the valve becomes narrowed, often because of progressive calcification. The heart then has to work harder to push blood through the restricted opening.

As the disease progresses, patients may develop:

• Breathlessness, particularly during activity
• Chest discomfort or pain
• Fatigue
• Dizziness or fainting
• Reduced exercise tolerance
• Swelling of the legs
• Heart failure symptoms

Severe symptomatic aortic stenosis is a serious condition. Without appropriate treatment, it can progressively affect heart function and quality of life.

Why Can TAVI Be Useful for Elderly Patients?

The main advantage of TAVI is that it avoids the large chest incision and cardiopulmonary bypass generally associated with conventional surgical aortic valve replacement.

During TAVI, a replacement valve mounted on a catheter is guided to the heart and positioned inside the diseased native valve. Once deployed, the new valve takes over the job of controlling blood flow from the heart.

This less invasive approach can mean:

• Less surgical trauma
• Shorter hospitalisation in suitable patients
• Faster physical recovery
• Earlier return to everyday activities
• An alternative for patients considered unsuitable or high-risk for open surgery

TAVR is a minimally invasive alternative to surgical valve replacement with its shorter recovery and hospital stay compared with conventional surgery. For an older patient who may take longer to recover from major surgery, these differences can matter considerably.

What Do TAVI Outcomes Look Like in Older Adults?

One of the most important outcomes is improvement in symptoms and daily functioning.

Patients who undergo successful TAVI for severe aortic stenosis may experience less breathlessness and fatigue and find that ordinary activities such as walking, climbing stairs or doing household tasks become easier.

TAVI has also demonstrated favourable outcomes compared with surgery in appropriately selected patients, particularly regarding early recovery. The 2025 ESC/EACTS guidance specifically notes that TAVI can reduce early adverse outcomes and accelerate recovery in suitable elderly patients.

However, age alone does not determine the outcome. An 80-year-old who remains physically active and otherwise healthy may have a very different risk profile from an 80-year-old with frailty, severe kidney disease or advanced lung disease. That is why a thorough assessment matters. 

Is TAVI Safe for Very Elderly Patients?

TAVI can be performed successfully in many patients in their 70s, 80s and beyond. But it is still a major cardiac procedure, and complications are possible.

Potential complications include:

• Bleeding or damage to the blood vessels
• Stroke
• Heart rhythm disturbances
• Need for a permanent pacemaker in some patients
• Leakage around the implanted valve
• Kidney-related complications
• Infection, although uncommon

The risk depends on the patient's health, valve anatomy, vascular access and the experience of the treating centre. There may also be vascular complications, stroke, paravalvular leakage and conduction problems among recognised TAVR risks.

What Happens Before TAVI?

TAVI is not simply a procedure that is chosen because a patient is elderly.

A Heart Team evaluates whether it is appropriate. Assessment generally includes an echocardiogram, ECG, blood tests and detailed imaging. CT imaging is particularly important for understanding the aortic valve, aortic root and blood vessels through which the catheter will travel.

Doctors also consider:

• Age and expected life expectancy
• Frailty and functional status
• Other medical conditions
• Surgical risk
• Valve anatomy
• Previous cardiac procedures
• Vascular access
• The patient's preferences

The updated European guidelines place particular emphasis on multidisciplinary Heart Team decision-making and patient-centred treatment selection. 

Recovery After TAVI

Recovery is generally quicker than after conventional open-heart valve replacement. Many patients are able to sit up and walk relatively soon after the procedure, followed by gradual return to normal activities.

The exact recovery period varies. Elderly patients may need additional attention to nutrition, mobility, medication management and rehabilitation, particularly if they were frail before the procedure. The aim is not simply to replace the valve. It is to help the patient regain functional independence.

TAVI at STAR Hospitals, Hyderabad

At STAR Hospitals, TAVR is part of its advanced structural heart and interventional cardiology services. Our cardiology department reports extensive experience with complex cardiac interventions, including TAVR, and uses advanced cardiac imaging and multidisciplinary evaluation for patients with structural heart disease. 

We have specialists with expertise in structural heart interventions. Dr. Rajesh Natuva, for example, lists TAVR among his areas of expertise and has undergone dedicated international training in structural heart interventions, including TAVR, TMVR and TEER.  This multidisciplinary approach is particularly important for elderly patients, who may have several medical conditions that need to be considered before, during and after valve replacement.