Understanding aortic stenosis: How TAVI can help
Cardiologist Dr Mohssen Chabok explains why TAVI is an effective treatment for patients with aortic stenosis – particularly those who are considered high-risk for traditional surgery.
Aortic stenosis is a common yet serious heart condition that affects thousands of people every year, particularly older adults. Fortunately, advances in treatment have made it easier than ever to manage this condition.
One of the most exciting developments is transcatheter aortic valve implantation (TAVI), a minimally invasive procedure providing new hope to patients who aren’t able to undergo open heart surgery. In this blog, we’ll take a closer look at aortic stenosis, including symptoms, how it’s diagnosed, and why TAVI might be the most effective treatment option for you.
What is aortic stenosis?
Aortic stenosis is a heart condition where the aortic valve (the ‘gateway’ between the heart's left ventricle and the aorta) becomes stiff and narrowed, restricting blood flow from the heart to the rest of the body.
When the aortic valve becomes narrowed, the heart must work harder to pump blood. This can lead to symptoms such as chest pain, shortness of breath, fatigue, dizziness, and in severe cases, syncope and heart failure.
Aortic stenosis is most often caused by age-related calcium build-up on the valve. It can also occur as a result of congenital defects (those present from birth) or complications from infections.
While some people may not experience symptoms for years, untreated severe aortic stenosis can be life-threatening.
Aortic stenosis symptoms
Symptoms often develop gradually and may include:
- chest pain or tightness, especially during physical activity
- shortness of breath, which worsens with exertion
- fatigue
- dizziness or fainting
- heart palpitations
- swelling in the ankles or feet, which can be a sign of heart failure
- a decline in your ability to do normal activities
Many people with aortic stenosis may not notice symptoms until the condition is at an advanced stage. However, if you begin to feel unusually fatigued or notice a decline in your ability to stay active – especially if you’re older – you should visit a specialist as soon as possible.
Aortic stenosis diagnosis
Aortic stenosis is typically diagnosed through a combination of a physical exam and various imaging tests that help assess how well your aortic valve is working and how severe the narrowing is.
Your consultant will begin the process by listening to your heart with a stethoscope. If they hear a heart murmur (a whooshing sound caused by a turbulent blood flow through the heart), they may suspect aortic stenosis. From there, they’ll recommend tests to confirm the diagnosis and understand how serious it is.
Common tests used to diagnose aortic stenosis include:
- Echocardiogram – The most important test, which shows how blood flows through the heart and how well the aortic valve opens and closes. It also helps measure how narrow the valve is.
- Electrocardiogram (ECG) – This records the heart’s electrical activity and can show signs of strain or rhythm problems, though it doesn’t diagnose stenosis directly.
- Chest X-ray or CT scan – These can reveal changes in lungs, heart size or calcium buildup on the valve.
- Exercise testing – Sometimes used to see how your heart responds to physical activity, especially if symptoms are unclear.
- Cardiac catheterisation – This is a more detailed test of coronary arteries that may be used if other results are inconclusive, or before planning treatment.
How fast does aortic stenosis progress?
Aortic stenosis can progress at different speeds depending on your age, overall health, and the cause of the condition. For many people, it develops slowly over several years without causing symptoms. However, once symptoms like chest pain, breathlessness, or fainting begin, aortic stenosis can rapidly worsen, and urgent treatment may be required.
Regular monitoring is important to catch changes early. Patients with mild cases are usually checked every few years, while moderate and severe cases need more frequent follow-ups. Heart scans like echocardiograms help track how well your valve is working and guide decisions about treatment.
Some people may see faster progression, especially if they were born with a valve problem or have other health issues like high blood pressure, diabetes, or kidney disease. Lifestyle factors such as smoking and high cholesterol can also speed things up.
Is aortic stenosis hereditary?
Aortic stenosis is usually caused by aging, but in some cases, it can run in families.
One common inherited cause is a condition called bicuspid aortic valve, where the valve has two flaps or leaflets instead of the usual three. This can lead to narrowing of the valve over time and is often passed down from parents to children.
There are also certain genes that may increase the risk of developing aortic stenosis, but having these genes doesn’t guarantee you’ll get the condition. Lifestyle factors like smoking, high blood pressure, and cholesterol also play a big role.
If someone in your family has aortic stenosis – especially at a younger age – it’s a good idea to talk to your doctor. They may recommend a heart check-up to see if you’re at risk.
Does aortic stenosis cause coughing?
Aortic stenosis can cause coughing, although it's not one of the more common symptoms.
Coughing may happen when the narrowed aortic valve makes it harder for the heart to pump blood effectively. This can lead to fluid build-up in the lungs, a condition known as pulmonary edema. When this happens, the cough may be persistent and can feel different from a typical cold or allergy-related cough. It might be dry and hacking, or in more serious cases, produce frothy or pink-tinged mucus.
The cough may also get worse when lying down or during physical activity, as these situations put extra strain on the heart. Not everyone with aortic stenosis will experience coughing, but if you do, it’s important to speak with a specialist – particularly if it's new or persistent.
Transcatheter aortic valve implantation (TAVI)
Transcatheter aortic valve implantation (TAVI) is a minimally invasive procedure used to treat aortic stenosis. While this condition was traditionally managed with open-heart surgery, TAVI now offers a less invasive alternative which is particularly well-suited for older adults or those considered high-risk for conventional surgery.
Unlike traditional valve replacement, TAVI does not require opening the chest or stopping the heart. Instead, a catheter is inserted through a blood vessel, usually in the groin, and guided to the heart. Through this catheter, a new valve is carefully positioned inside the narrowed aortic valve and expanded to take over its function. The procedure is typically performed under local anaesthesia or light sedation, and most patients are able to go home within a couple of days.
TAVI is particularly beneficial for those who may not tolerate major surgery well, such as elderly patients or those with other medical conditions. It offers a faster recovery time, reduced hospital stays, and significant improvement in symptoms like breathlessness, chest pain, and fatigue. Many patients report feeling better within days and are able to return to normal activities much sooner than with traditional surgery.
Like any medical procedure, TAVI carries certain risks, including valve leakage (paravalvular regurgitation), stroke, vascular complications, kidney damage, or the need for a permanent pacemaker. However, these risks are generally low.
Nowadays, TAVI is considered as effective as open heart surgery for many patients with severe aortic stenosis. Recent studies and NHS guidance have led to its wider adoption, not only for those at high surgical risk but also for patients at intermediate and even low risk – making it a viable option for a broader range of individuals.
Benefits of TAVI
There are several key benefits to TAVI for patients with aortic stenosis:
- Minimally invasive approach: TAVI is carried out using a catheter inserted through a blood vessel, typically in the groin, which means there's no need for open-heart surgery. This reduces physical trauma, avoids large incisions, and eliminates the need to stop the heart during the procedure.
- Faster recovery time: Because TAVI is less invasive, patients often experience shorter hospital stays and a quicker return to everyday activities. This is especially beneficial for older adults or those with limited mobility.
- Improved quality of life: With reduced symptoms and a faster recovery, patients often experience a noticeable improvement in their overall well-being, independence, and ability to participate in daily life.
- Suitable for high-risk patients: TAVI is particularly suitable for patients who are considered high-risk for traditional surgery due to age, frailty, or other health conditions. It offers a safer alternative with fewer complications and less strain on the body.
- Comparable effectiveness to surgery: Clinical studies have shown that TAVI provides outcomes similar to open heart surgery in terms of survival and symptom improvement. It is now approved for use in patients at intermediate and even low surgical risk.
How long does a TAVI procedure take?
A TAVI procedure typically takes about one to two hours from start to finish. It’s much shorter than traditional open heart surgery and is usually performed in a catheter lab.
After the procedure, patients are monitored closely and usually stay in hospital for one to three days, depending on recovery and overall health. Many people can return to normal activities within a week or two.
How long does a TAVI valve last?
TAVI valves are designed to be durable, and current research shows they can last at least 10 to 15 years in many patients. Most people still have a well-functioning valve six to eight years after the procedure, and ongoing studies continue to monitor long-term performance.
The exact lifespan of a TAVI valve can vary depending on factors like:
- age and overall health
- activity level
- type of valve used
- presence of other medical conditions, such as kidney disease or diabetes
Because TAVI is a relatively newer procedure compared to surgical valve replacement, long-term data beyond 15 years is still being collected. However, current results are promising and suggest that TAVI valves offer good durability for most patients.
How much does a TAVI procedure cost?
For the latest self-pay pricing, please visit our dedicated TAVI webpage.
At Cromwell Hospital, TAVI is offered as a fixed price package. This means that everything you may need for treatment is grouped into one clear price, including pre-admission tests, the procedure, professional fees, post-op outpatient care, and any other consultant-recommended services.
TAVI may also be covered by your private medical insurance. Please confirm with your insurer before booking an appointment at the hospital.
This service is led by Dr Tito Kabir and Dr Mohssen Chabok, Consultant Cardiologists.
