TAVI / TAVR in Mumbai: A Cardiac Surgeon's Perspective

If you or a parent has been told the aortic valve is severely narrowed, you've probably heard two very different options — a valve fitted through a catheter in the leg (TAVI), or open-heart surgery. And you may have noticed that the answer you get seems to depend on which specialist you ask. Let me offer you something different: the view of a surgeon who performs both.

TAVI — transcatheter aortic valve implantation, also called TAVR — replaces a diseased aortic valve without opening the chest or stopping the heart. Because I do both TAVI and open valve surgery, I have no reason to steer you towards one or the other. My only job is to work out which is genuinely right for your heart.

TAVI is a way to replace the aortic valve from the inside. Instead of opening the chest, I guide a new tissue valve — mounted on a small frame — up through the artery in the leg and position it inside the old, diseased valve, where it immediately takes over the job. For the right patient, it means a shorter hospital stay and a much faster recovery than open surgery.

The condition it treats most often is severe aortic stenosis — a narrowing of the aortic valve that forces the heart to strain against a smaller and smaller opening. Over time that causes breathlessness, chest tightness, giddiness, and fatigue, and once it becomes severe and symptomatic it is genuinely dangerous if left untreated. Replacing the valve relieves the obstruction and protects the heart. TAVI is also increasingly used to treat a worn-out tissue valve from a previous surgery — a valve-in-valve procedure.

TAVI is often associated with interventional cardiology, and cardiologists do superb work. But the safest, most balanced valve care comes from a Heart Team — a cardiac surgeon and an interventional cardiologist reviewing your case together — and having a surgeon in that room matters for three practical reasons:

• Unbiased advice. Because I can perform either operation, my recommendation is based on what's best for your heart, not on the only tool I carry.
• A surgical safety net. The safest TAVI programmes are built around a team with a cardiac surgeon present. In the rare event of a complication during the procedure, surgical expertise and backup are immediately on hand.
• The full journey. From standard TAVI to alternative access routes, complex anatomy, and future valve-in-valve procedures — and the moments when open surgery is genuinely the better choice — a surgeon can manage the whole path.

TAVI is done in a cath lab or a hybrid operating theatre. I pass a catheter through the femoral artery in the leg and guide the new valve up to the heart, where it's deployed inside the diseased valve under X-ray guidance. The new valve takes over immediately. In many cases general anaesthesia isn't needed, and patients often go home in about three days. When the leg artery isn't suitable, a surgeon can use an alternative access route to deliver the valve safely — another reason surgical involvement helps.

TAVI is especially valuable for patients with severe aortic stenosis who face higher risk from open surgery — often older patients (frequently over 70), those unfit for conventional surgery, or those with other serious conditions such as lung disease or cancer. The evidence has steadily widened who can be considered, but the final call always rests with the Heart Team after assessing the heart, the valve anatomy, and the patient's overall health.

Supporting evidence: In the PARTNER 3 trial (Mack et al., NEJM 2019), TAVI was at least as good as surgery for low-risk patients at one year; longer-term follow-up shows the two approaches converge over the years, which underlines why valve durability matters, particularly for younger patients — PARTNER 3 trial (NEJM 2019)

Because I perform both, I can lay these out side by side without a thumb on the scale. Neither is universally better — they're better for different patients.

For the right patient, the advantages are real and immediate: no chest incision and no divided breastbone, no need to stop the heart, often no general anaesthesia, a hospital stay of around three days, and a quick return to normal life. For an older or frailer patient who would find open surgery a hard road, that gentler path can be the difference between having the valve treated and not.

TAVI is generally very safe, but I always discuss its considerations plainly. Only tissue valves can be used, so long-term durability is a genuine factor — one of the main reasons I may still favour surgery for a younger patient. There's a higher chance of needing a permanent pacemaker afterwards than with open surgery, and the valve and procedure cost considerably more. As with any valve procedure, there are small risks related to the blood vessels, bleeding, or the valve's position. Weighing all of this against the benefits is precisely what the Heart Team assessment is designed to do.

Fast recovery is one of TAVI's biggest attractions. Most patients are encouraged to move about soon after the procedure, spend only a few days with us, and return to their normal routine quickly — far sooner than after open surgery. Good blood-pressure control and regular follow-up help make the result last.

TAVI Recovery Roadmap

Most patients feel a marked improvement in breathlessness and energy once the narrowed valve is relieved — it can be quite dramatic. Long-term care is straightforward: regular follow-up with echocardiograms to monitor the new valve, good control of blood pressure and other risk factors, and staying active. Because TAVI uses a tissue valve, you generally won't need lifelong blood thinners the way a mechanical valve requires — though I'll always advise you on the right medication for your situation.