TAVI, also called TAVR, has changed the way many people with severe aortic stenosis can be treated. Instead of replacing the aortic valve through open-heart surgery, TAVI allows a new valve to be delivered through a catheter and positioned inside the diseased valve.
But having aortic stenosis does not automatically mean that TAVI is the right treatment. Eligibility depends on several factors, including the severity of the valve disease, age, symptoms, overall health, life expectancy, valve anatomy, vascular access and whether surgery may provide a better long-term option. If you want to understand the procedure itself, you can also read our guide to TAVI/TAVR treatment.
Who is generally considered for TAVI?
TAVI is primarily considered for people who have severe aortic stenosis and require aortic valve replacement. The procedure is particularly important for older adults and for patients in whom a less invasive valve replacement may offer advantages over open surgery.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
Current recommendations have expanded the group of patients who may be considered for TAVI. For patients aged 70 years or older with a tricuspid aortic valve and suitable anatomy, TAVI is recommended when the anatomy is appropriate. For younger patients, surgical aortic valve replacement is more often favoured when surgical risk is low, although individual assessment remains essential.
Therefore, there is no single age at which everyone should have TAVI. Age is one part of a much broader treatment decision.
The first question: Does the patient actually need valve replacement?
Before deciding whether someone is eligible for TAVI, doctors first determine whether the aortic stenosis is severe enough to require an intervention.
Evaluation usually includes echocardiography and other investigations that assess the degree of valve narrowing, blood-flow measurements, left ventricular function and the amount of valve calcification. Symptoms and the effect of the disease on daily activities are also important. Valve replacement is commonly considered when severe aortic stenosis is causing symptoms such as:
- Shortness of breath, particularly during activity
- Chest discomfort or angina
- Dizziness or fainting
- Reduced exercise tolerance
- Fatigue or a noticeable decline in physical activity
Age matters — but it is not the only factor
Age has an important role in choosing between TAVI and surgical aortic valve replacement because the decision needs to consider both immediate treatment and the patient's longer-term valve needs.
Under the 2025 European recommendations, TAVI is recommended for patients aged 70 years or older with tricuspid aortic stenosis when the anatomy is suitable. For patients younger than 70 who have low surgical risk, surgery is generally recommended.
However, people do not fall into perfectly defined age groups. A patient's overall health, expected longevity, other medical conditions, valve anatomy and preferences can change the balance between TAVI and surgery.
What does “suitable anatomy” mean?
One of the most important parts of TAVI assessment is determining whether the patient's heart and blood vessels are anatomically suitable for the procedure.
Doctors use detailed imaging, often including CT angiography, to study the aortic valve and surrounding structures. This helps determine whether a replacement valve can be safely positioned and whether the catheter can reach the heart through an appropriate access route.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
The assessment may include:
- The size and shape of the aortic valve annulus
- The number and structure of the valve leaflets
- The pattern and amount of valve calcification
- The position of the coronary arteries
- The size and condition of the blood vessels used for catheter access
- The anatomy of the aortic root and surrounding structures
Why the type of aortic valve matters
Most people have a tricuspid aortic valve, meaning the valve has three leaflets. Some people are born with a bicuspid aortic valve, which has two leaflets.
Bicuspid anatomy can make TAVI planning more complex because the shape and calcification pattern of the valve may differ from those of a typical tricuspid valve.
This does not mean that every person with a bicuspid valve is automatically excluded from TAVI. However, younger patients with bicuspid anatomy are often more likely to be considered for surgery, particularly when surgical treatment can address other problems at the same time.
Overall health can influence TAVI eligibility
TAVI is less invasive than conventional open-heart valve replacement, which can make it particularly useful for patients who may face greater challenges with surgery. Doctors therefore consider conditions such as:
- Frailty and general physical condition
- Kidney or lung disease
- Previous heart surgery
- Other cardiovascular conditions
- Previous chest radiation or other factors that may increase surgical complexity
- Other significant medical conditions that could affect recovery
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
Importantly, being considered “high risk” for surgery is no longer the only reason someone may receive TAVI. Current evidence and guidelines support TAVI across a broader range of surgical-risk groups when the patient's overall clinical and anatomical profile makes it appropriate.
Life expectancy and quality of life are part of the decision
A valve replacement should provide a meaningful benefit. For this reason, doctors consider not only whether the procedure can technically be performed, but also whether it is likely to improve survival, symptoms or quality of life.
Severe illnesses unrelated to the heart may affect this decision. If another serious condition is likely to limit life expectancy or prevent meaningful improvement after valve replacement, the expected benefits of TAVI may be smaller. This is why TAVI eligibility cannot be determined from an echocardiogram alone.
When might surgery be preferred over TAVI?
TAVI can be an excellent option, but it is not automatically the best treatment for every patient with severe aortic stenosis. Surgical aortic valve replacement may be preferred when:
- The patient is younger and has a long expected lifetime with the valve
- The patient has a bicuspid aortic valve in circumstances where surgery offers advantages
- Other heart conditions require surgery at the same time
- The patient's aortic or vascular anatomy is unsuitable for TAVI
- The expected long-term benefits of surgery are considered greater
What tests are done before deciding on TAVI?
Once TAVI is being considered, the patient undergoes a detailed assessment rather than a single eligibility test. This may include:
- Echocardiography: to assess the severity of aortic stenosis, valve function and heart function.
- CT imaging: to assess the aortic valve, annulus, coronary anatomy, aortic root and potential catheter access routes.
- Electrocardiogram: to evaluate the heart's electrical activity and identify existing conduction abnormalities.
- Blood tests: to assess kidney function, blood counts and other factors relevant to treatment.
- Assessment of overall health: to understand frailty, other illnesses, functional status and expected recovery.
- Coronary assessment when appropriate: to identify significant coronary artery disease that may influence treatment planning.
The Heart Team makes the final decision
One of the most important points about TAVI eligibility is that the decision is usually not made by looking at one factor in isolation.
A multidisciplinary Heart Team brings together specialists who assess the patient's clinical condition, imaging findings, surgical risk, anatomy and long-term treatment needs. The patient's own preferences and priorities are also part of the decision.
The goal is not simply to determine whether TAVI can be performed. The goal is to determine whether TAVI is the most appropriate valve replacement strategy for that particular patient.
Can someone be too old or too sick for TAVI?
There is no simple age cutoff that automatically makes a person too old for TAVI. In fact, TAVI can be particularly valuable for older adults because it avoids many aspects of conventional open-heart surgery.
However, advanced age alone does not guarantee that TAVI will be beneficial. Doctors also consider frailty, other illnesses, life expectancy, functional status and whether treating the valve is likely to improve the patient's quality of life.
Similarly, having multiple medical conditions does not automatically rule out TAVI. The key question is whether the overall balance of potential benefits and risks is favourable.
Quick guide: factors that influence TAVI eligibility
| Factor | Why it matters |
|---|---|
| Severe aortic stenosis | Determines whether valve replacement is needed |
| Symptoms and heart function | Helps determine the urgency and benefit of intervention |
| Age | Influences the balance between TAVI and surgery |
| Aortic valve anatomy | Determines whether the replacement valve can be safely positioned |
| Vascular access | Determines whether the catheter can safely reach the heart |
| Other medical conditions | Influence procedural risk and expected benefit |
| Life expectancy | Helps determine whether valve replacement is likely to provide meaningful benefit |
| Need for other cardiac surgery | May make surgical valve replacement more appropriate |
| Patient preference | Forms part of shared decision-making when both approaches are reasonable |
The Bottom Line
Being eligible for TAVI is about much more than having a narrowed aortic valve or reaching a particular age. The patient generally needs aortic stenosis severe enough to warrant valve replacement, while the anatomy must allow a transcatheter valve to be implanted safely.
Age, symptoms, heart function, valve anatomy, vascular access, surgical risk, other medical conditions, life expectancy and future treatment needs all influence the decision. Under current European guidance, TAVI has an important role in patients aged 70 years or older with suitable tricuspid aortic valve anatomy, while surgery continues to be particularly important for many younger, low-risk patients and for situations where other cardiac conditions need to be treated surgically.
Ultimately, TAVI eligibility is an individualized decision made by the Heart Team. The most appropriate treatment is the one that offers the best balance of safety, effectiveness, quality of life and long-term valve strategy for the individual patient.
