When a cardiologist recommends TAVI, patients and their families often want to know how the procedure works. It involves replacing the aortic valve through a catheter, usually without opening the chest. However, the tests and assessments carried out beforehand are just as important. They help doctors decide whether TAVI is suitable and plan the procedure according to the patient's needs. Understanding these steps can also help patients feel more prepared for the treatment ahead.

What is TAVI, briefly?

Transcatheter aortic valve implantation (TAVI, also called TAVR) treats severe aortic stenosis, a narrowing of the valve that lets blood leave the heart's main pumping chamber. A replacement valve is compressed onto a catheter, guided to the heart, usually from an artery in the groin, and expanded inside the old valve. It is a widely used alternative to open surgical valve replacement, particularly for older patients.

Step one: confirming the problem

Everything starts with an echocardiogram, an ultrasound scan of the heart. It shows how narrow the valve is, how fast blood is being forced through it and how well the heart muscle is coping. Doctors look for the combination of severe narrowing and symptoms such as breathlessness, chest tightness, dizziness or fainting. Severe stenosis without symptoms is sometimes monitored rather than treated straight away, so expect questions about exactly what you can and cannot do day to day.

Step two: the CT scan

The most technical part of the work-up is a contrast CT scan of the heart, aorta and leg arteries. It measures the valve opening to the millimetre so the right size of replacement valve can be chosen, and it checks whether the arteries in the legs are wide enough to carry the catheter. If they are not, a different access route may be planned. Because the scan uses contrast dye, kidney function is checked first.

Step three: the coronary arteries

Many people with aortic stenosis also have narrowed coronary arteries. These are often assessed with coronary angiography or with the CT scan itself. If significant blockages are found, the team will decide whether they need treatment before, during or after the valve procedure.

Step four: the whole person

TAVI assessment focuses on whether the procedure is likely to improve the patient’s health and quality of life, as well as whether valve replacement is technically possible. This usually involves:

• A review of other conditions, such as diabetes, lung disease and kidney function, which affect risk.
• A frailty and mobility assessment, because a new valve cannot reverse every cause of tiredness or weakness.
• A dental check, since infection can settle on an artificial valve.
• A conversation about goals. For some people the aim is to keep living independently; for others it is simply to breathe more easily.

Step five: the heart team decision

International guidelines recommend that the choice between TAVI and open surgery is made by a heart team, typically an interventional cardiologist and a cardiac surgeon reviewing the results together, with imaging specialists and anaesthetists involved. Age, anatomy, other illnesses and the expected lifespan of the new valve all feature in the discussion. Younger patients are more often steered towards surgery, because a surgically implanted valve has longer durability data.

Questions worth asking

Why is TAVI being recommended over surgery, or the reverse? What did the CT scan show about the access route? Do my coronary arteries need treatment too? What is my personal risk of needing a pacemaker afterwards? Who will follow me up once I go home?

Choosing where to go

Families comparing options are sometimes drawn to whichever name appears as the top cardiology hospital in Dubai in a search result. A more useful test is whether the hospital runs a genuine heart team, offers both TAVI and open valve surgery, and can explain clearly why one has been chosen for you.

Where is TAVI available in Dubai?

Aster Hospitals, a Dubai hospital group whose facilities include Aster Hospital Mankhool, Aster Hospital Al Qusais and Aster Cedars Hospital & Clinic in Jebel Ali, offers transcatheter aortic valve replacement in Dubai. According to the group, interventional cardiologists, cardiothoracic surgeons, radiologists, and anaesthesiologists assess candidates, and the multidisciplinary heart team agrees on valve treatment pathways before making a recommendation. 

Aster Hospital was ranked 2nd in the UAE for cardiology in Newsweek's World's Best Specialised Hospitals 2027, powered by Statista. Before proceeding with TAVI, patients should understand why it has been recommended, what the procedure involves and what to expect afterwards. A clear discussion with the heart team can help patients and their families approach treatment with greater confidence.