Questions to Ask Your Cardiologist About TAVR: A Decision-Support Checklist
Key takeaways
- The most useful questions fall into five groups: am I a candidate, which valve and why, how long will it last, what are my personal risks, and how experienced is this team.
- Ask how severe your aortic stenosis is in numbers, because the decision rests on measurements: severe is a valve area below 1.0 cm², a mean gradient above 40 mmHg, or a peak jet velocity above 4 m/s.
- Ask specifically about durability and age: TAVR valves show good durability to about 5 to 8 years in trials, so if you are younger the plan for a second valve later matters.
- Ask for your risks as numbers, not reassurances: contemporary 30-day mortality is around 1 to 2% in lower-risk patients, stroke around 2 to 3%, and a new pacemaker is needed in about 10 to 20% of cases.
- The decision is made with a multidisciplinary heart team through shared decision-making, so it is entirely reasonable to ask about the team's volume and to take time before you consent.
Updated
The most useful questions to ask your cardiologist about TAVR fall into five groups: am I a candidate, which valve and why, how long will it last, what are my personal risks, and how experienced is this team. When I sat in that consultation at 74, I did not know what I was allowed to ask, so I nodded a lot and understood little. This is the checklist I would hand my younger self, organised the way a good conversation actually flows.
Am I a candidate, and how was that decided?
Start by asking how severe your aortic stenosis really is, because the whole decision rests on measurements rather than impressions. Severe aortic stenosis is defined as a valve area below 1.0 cm², a mean gradient above 40 mmHg, or a peak jet velocity above 4 m/s 1. Ask for your own numbers and whether you have symptoms, because it is severe symptomatic disease that most clearly calls for treatment; left untreated, survival is often quoted as around 50% at 2 years 2.
Then ask who decided you are a candidate. Candidacy is settled by a multidisciplinary heart team, a cardiologist, a cardiac surgeon, and imaging specialists together, weighing your age, surgical risk, the anatomy on your CT scan, and your other conditions 3. It is fair to ask what your CT showed and what your surgical risk score was. The fuller picture of who qualifies sits in am I a candidate for TAVR, and the procedure itself in what is TAVR.
Which valve, and why that one?
Ask which type of valve they plan to use and why it suits your anatomy. There are two main designs, balloon-expandable and self-expanding, and both are bioprosthetic tissue valves 1. The choice is not marketing; it turns on the size and shape of your valve and the surrounding vessels on the CT scan, and on how the team reads the risk of complications such as a leak or the need for a pacemaker.
A practical follow-up is to ask what the valve is made of and what that means for your medication, since tissue valves do not require lifelong warfarin the way mechanical valves do 1. When I asked why my particular valve had been chosen, the honest answer was that my anatomy pointed to one option, which was oddly reassuring: it meant the decision was about me, not a default.
How long will it last, and what happens when it wears out?
Ask directly how long this valve is expected to last, and what the plan is when it does wear. Bioprosthetic valves are not permanent: surgical tissue valves last roughly 10 to 15 years, and TAVR valves show good durability to about 5 to 8 years in trials, with longer-term data still maturing 1. Durability matters most in younger patients, who may outlive the valve and need a second procedure.
So if you are younger, ask specifically whether a future valve-in-valve TAVR (a new valve placed inside the old one) would be possible for you, because that changes how the decades ahead look. This is the heart of how long a TAVR valve lasts, and it is a question age alone should not answer for you.
What are my risks, in numbers?
Ask for your risks as figures, not reassurances. In contemporary practice, 30-day mortality is low, around 1 to 2% in lower-risk patients; stroke around the procedure runs at roughly 2 to 3%; and a new permanent pacemaker is needed in about 10 to 20% of cases, higher with self-expanding valves at roughly 15 to 25% 4. It is reasonable to ask which of these your own anatomy pushes up or down.
Ask too about paravalvular leak (a small gap around the valve) and access-site or bleeding complications, so nothing is a surprise. Precise numbers are not there to frighten you; they are there to let you weigh the procedure honestly. The full breakdown lives in TAVR risks and complications.
How experienced is this team, and what before I consent?
Ask how many TAVR procedures the centre performs and whether it runs a formal heart team, because experience and a genuine multidisciplinary approach are reasonable markers of quality. It is also fair to ask how your hospital stay compares: TAVR stays are typically 1 to 3 days versus about 5 to 7 days for open surgical replacement 5, which is part of why the procedure has spread from inoperable patients across the whole risk spectrum.
Before you consent, settle the human questions: what happens if you do nothing, what surgery would involve for you, and why the team recommends this path. Guidelines frame all of this as shared decision-making, which means you are meant to understand and agree, not simply sign 3. When I finally asked to take the information home overnight, no one blinked, and I walked back in the next day understanding my own heart for the first time.
General information, not medical advice. Whether TAVR is right for you is a decision for your own heart team, who can examine you, read your scans, and weigh your specific risks; use these questions to inform that conversation, not to replace it.
References
- 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease, American College of Cardiology / American Heart Association. ↩
- Heart Valve Problems and Disease, American Heart Association. ↩
- 2021 ESC/EACTS Guidelines for the management of valvular heart disease, European Society of Cardiology. ↩
- TAVI (transcatheter aortic valve implantation), British Heart Foundation. ↩
- Heart valve disease presenting in adults: investigation and management (NG208), National Institute for Health and Care Excellence. ↩
Common questions
What is the single most important question to ask about TAVR?
If you ask only one thing, ask the heart team to explain, in your specific case, why they are recommending TAVR over surgery or over waiting, and what they would do if it were their own relative. That question forces a personalised answer rather than a general one, and it usually surfaces the trade-offs that matter most for you: your age, your anatomy on the CT scan, your other health conditions, and how those tip the balance. Everything else on a checklist flows from that central judgement.
How do I ask about the surgeon or centre's experience without causing offence?
Directly and politely, because it is a fair question that good teams expect. You can ask how many TAVR procedures the centre does each year and whether they have a formal heart team. Volume and a genuine multidisciplinary team are reasonable markers of experience. Framing it as 'I want to understand where this fits in your regular practice' keeps it collaborative. A confident team will answer without hesitation, and any reluctance to discuss it is itself informative.
Should I ask about alternatives to TAVR?
Yes, always. The honest alternatives are surgical valve replacement, and in some cases careful monitoring if the stenosis is not yet severe or symptomatic. Ask what happens if you do nothing, what surgery would involve for you specifically, and why the team is steering towards one option. The point is not to second-guess the experts but to understand the whole map, so that the recommendation makes sense to you rather than simply being accepted.
What should I ask about recovery and life afterwards?
Ask how long you are likely to stay in hospital, when you can expect to be back to normal activity, what medication you will be on and for how long, and how your valve will be monitored in the years ahead. These questions matter because a valve procedure is the start of a lifelong relationship with a cardiology team, not a one-off repair. Knowing the follow-up plan up front makes the whole thing feel less like a leap into the unknown.
Is it reasonable to ask for time before consenting to TAVR?
Yes, unless the situation is a genuine emergency, and most are not. Severe symptomatic aortic stenosis needs prompt attention, but prompt does not mean same-day without questions. Asking to take the information home, to bring a family member to the next appointment, or to have something explained again is normal and expected. A good team supports shared decision-making, which by definition means you understand and agree with the plan rather than simply signing where indicated.
What questions should a younger patient ask about TAVR specifically?
Durability and the long-term plan. Because tissue valves are not permanent, a younger patient is more likely to outlive the first valve and need a second procedure. Ask how long this valve is expected to last for someone your age, whether a future valve-in-valve TAVR would be possible, and how the choice between TAVR and surgery changes the options decades from now. This is exactly the sort of question the guidelines expect to be weighed through shared decision-making, not decided by age alone.
Written by Diane Farrow. Medically reviewed by Dr. Helena Voss, MD, FESC.
Our guides are written from personal experience and reviewed by a qualified clinician for accuracy. Read our editorial policy.
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