When is the valve replaced at all?

Aortic stenosis is a narrowing of the valve between the heart and the body's main artery. A mildly narrowed valve is usually watched rather than treated. Replacement is considered when the narrowing becomes severe and starts to cause symptoms — breathlessness, chest tightness, light-headedness or fainting on exertion — or when the heart muscle begins to struggle even before symptoms appear [1][3]. No medication can reverse the narrowing itself [1][5].

The two options, side by side

Surgical aortic valve replacement is an operation under general anaesthetic: the surgeon removes the narrowed valve and sews a new one — mechanical or biological — in its place [3][5]. TAVI (transcatheter aortic valve implantation) replaces the valve without opening the chest: a folded valve is passed along a thin tube, usually from an artery at the top of the leg, and opened inside the old one [4][6].

  • Hospital stay — many people go home within days of a TAVI; after open surgery a stay of around a week is typical [5][6].
  • Recovery — full recovery from open surgery is usually measured in weeks to a few months; recovery after TAVI is generally quicker. Both vary from person to person [5][6].
  • Risks — both are significant procedures with real risks, and they differ in kind: TAVI, for example, carries a chance of needing a permanent pacemaker afterwards [4][5].
  • The years ahead — for younger patients, how long a new valve will last, and what could be done when it eventually wears, weighs in the decision [1][2].

How the decision is actually made

International guidelines are clear that this choice should not be made by one doctor alone: it belongs to a Heart Team — a cardiac surgeon, an interventional cardiologist and an imaging specialist assessing the case together [1][3].

Age is a starting point, not the answer. TAVI is generally favoured in older patients, while open surgery remains the standard for younger patients at low surgical risk [2][3]; the 2025 European guideline update places that boundary at around the age of 70 [2]. Around that starting point the team weighs the individual: overall fitness and frailty, the anatomy of the valve and of the arteries that would carry a TAVI, how much calcium has built up, whether anything else — such as narrowed coronary arteries — should be treated at the same time, and what matters most to the patient [1][3].

Before a TAVI, a detailed CT scan is taken to size the new valve and plan its route [1][3].

This is how WellHeart London is built: a cardiac surgeon, an interventional cardiologist and a consultant cardiac radiologist assess the case and agree the recommendation together — including whether treatment is needed at all.

What to ask

Whichever way your care goes, these questions belong in the conversation:

  • How severe is my narrowing, and is it what is causing my symptoms?
  • Am I a candidate for both options — and if not, why?
  • What does each option mean for me in the first month, and in ten years?
  • Who is on the team making this recommendation?

A narrowed valve, weighed properly

If you have been told your aortic valve is narrowed and are weighing what happens next, a structured review of your echocardiogram and imaging can set out exactly where you stand — and which options are genuinely open to you.