Am I a Candidate for TAVR? The Heart Team, the CT Scan, and How the Decision Is Made

Whether you are a candidate for TAVR is decided by a multidisciplinary heart team, using a CT scan of your valve and arteries, a measure of your surgical risk, and your age, not by any one doctor and not by a simple rule. When I asked my cardiologist “so, can I have the keyhole one?”, I expected a yes or a no on the spot. Instead my case went to a team, my scans were pored over, and a week or so later I had a recommendation I could trust precisely because more than one specialist had weighed it. Here is what actually goes into that decision.

Do you have severe aortic stenosis?

The first question is not about TAVR at all; it is whether your aortic stenosis is severe enough to warrant replacing the valve. Mild and moderate narrowing is monitored, not treated, so candidacy for any valve replacement starts with confirming severe disease ¹.

On an echocardiogram, severe aortic stenosis means a valve area below 1.0 cm squared, a mean gradient above 40 mmHg, or a peak jet velocity above 4 m/s, and replacement is usually considered once that severe narrowing is causing symptoms ². The reason for acting is the outlook: once severe aortic stenosis becomes symptomatic, survival is often quoted at around 50% at 2 years without valve replacement ¹. If you do not have severe stenosis, the honest answer is that you are not yet a candidate for any replacement, TAVR included. The condition itself is explained in aortic stenosis.

The heart team decides, not one doctor

Candidacy for TAVR is settled by a multidisciplinary heart team, at least an interventional cardiologist, a cardiac surgeon, and imaging specialists, reviewing your case together. This is written into the guidelines deliberately, so that the person who does TAVR and the person who does the operation weigh the options side by side ¹.

The point is balance. A cardiologist alone might lean towards the catheter; a surgeon alone might lean towards the operation. Together they are meant to reach the recommendation that genuinely fits you ³, weighing procedure-specific trade-offs such as the 10 to 20% chance that TAVR leaves you needing a new permanent pacemaker ¹. It was oddly reassuring to learn my “yes” had come from a room of people rather than one, and it is worth knowing so you can ask whether your own case has been through a heart team.

What the CT scan is for

A CT scan is central to TAVR candidacy because it measures your valve precisely and maps the arteries the catheter must travel through. It does two things at once. It sizes the aortic valve so the team can select the correct size of replacement, since a valve too small or too large will not seat and seal properly ⁴.

It also traces the arteries from the groin up to the heart, checking they are wide and healthy enough to carry the catheter, which decides whether the preferred transfemoral route through the groin is possible ⁴. Getting the sizing and the access route right is part of why contemporary TAVR carries a 30-day mortality of only around 1 to 2% in lower-risk patients ¹. If those arteries are too narrow or heavily diseased, an alternative access route may be needed, or the balance may tip towards surgery. The CT is the scan that turns “you might be suitable” into a firm plan.

Age, risk, and durability

Age and surgical risk are weighed heavily, because guidelines broadly favour TAVR in older and higher-risk patients and surgery in younger ones. The team estimates your operative risk using scores such as the STS score, which combine age, other conditions, and heart function to place you on the risk spectrum ².

Age carries a second, subtler weight: durability. TAVR uses a tissue valve, and tissue valves wear out, showing good durability to about 5 to 8 years in trials with longer data still maturing, against roughly 10 to 15 years for surgical tissue valves ⁵. A younger patient may well outlive the valve and need a second procedure later, which is why durability matters most in the young and is a large part of why they are more often offered surgery. The full picture is in how long a TAVR valve lasts. At 74 I was comfortably in the group for whom a tissue valve is expected to outlast the need, which made the sums simpler for me than they are for someone of 55.

Shared decision-making, and your part in it

The final step is shared decision-making: the heart team brings a recommendation, and you weigh it against your own priorities before agreeing a plan. Guidelines are explicit that where more than one reasonable option exists, your values and preferences are part of the decision, not an afterthought ¹.

The stakes on one side are clear: severe symptomatic aortic stenosis left untreated carries survival of only around 50% at 2 years, which is what any procedure’s risks are being weighed against ¹. That means it is entirely appropriate to ask why one route is recommended over the other, what it means for your particular anatomy, and what happens years down the line. I wish I had gone in with my questions written down; it is easy to nod along in the moment and think of everything afterwards in the car. A prepared list is in questions to ask your cardiologist about TAVR. Being a candidate for TAVR is ultimately a conversation, and you are one of the people in it.

---

General information, not medical advice. Candidacy for TAVR turns on your own severity, anatomy, risk, and age, and it is a decision for your own heart team, who can examine you and read your scans, not one an article can make for you.