The TAVR Procedure: What Happens on the Day, Step by Step

Key takeaways

On the day, a folded valve is threaded up through an artery in your groin (the transfemoral route) and opened inside your old aortic valve while your heart keeps beating.
Most patients are sedated but awake rather than put fully under, because TAVR does not open the chest or stop the heart.
The old valve is never removed: the new tissue valve is expanded inside it, either by a balloon or by a self-expanding frame.
The catheter part is usually over in about one to two hours, and the hospital stay afterwards is typically 1 to 3 days.
You wake in a recovery area with a dressing over the groin, not with a chest wound; the soreness is in the leg, not the breastbone.

By Diane Farrow | Medically reviewed by Dr. Helena Voss, MD, FESC

Published March 5, 2026

On the day of a TAVR, a new aortic valve is folded up small, threaded on a catheter up through the artery in your groin, and opened inside your worn-out valve while your heart carries on beating, usually while you are sedated but awake rather than fully under. No chest is opened, no breastbone is sawn, and the heart is not stopped. I had mine at 74, and the thing that stayed with me is how little it resembled the operation I had braced myself for. This is what actually happens, hour by hour, so the day holds no nasty surprises. For the wider picture of the procedure and why it exists, start with what TAVR is.

Before the day: the tests that fix your access route

Before you arrive, the team has already mapped the exact route and valve size from a CT scan, so the day itself is mostly a rehearsed plan. TAVR treats severe aortic stenosis, which 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. The CT measures the old valve and, just as importantly, the width and health of the arteries in your groin, because those decide whether the standard transfemoral route through the femoral artery can be used ².

You will usually be told to stop eating for several hours beforehand, to pause certain medicines, and to have some bloods and a heart trace done. In my case the pre-admission nurse walked me through all of it a week ahead, and knowing the groin was the way in, not my chest, was the first time the whole thing stopped frightening me.

Awake or asleep: conscious sedation or a general anaesthetic

Most transfemoral TAVRs are now done under conscious sedation, meaning you are relaxed and pain free but breathing for yourself, not under a full general anaesthetic. This is possible precisely because the procedure works on a beating heart through a small groin puncture rather than an open chest ³. The lighter approach is part of why the hospital stay is typically only 1 to 3 days, compared with about 5 to 7 days for open surgical replacement ².

A general anaesthetic is still chosen for some people, depending on the access route, the anatomy, or other health conditions, and that is a team decision made in advance. I was sedated, drowsy and warm, aware of quiet voices and the odd instruction, and I genuinely dozed through the middle of it. Ask which you are having; it changes how the day feels more than almost anything else.

Inside the catheter lab, step by step

In the catheter lab the new valve is guided up to your heart on a wire and expanded inside the old one, which is left in place rather than removed. The groin is numbed, a thin tube is passed into the femoral artery, and under X-ray and ultrasound guidance the folded valve is steered up to the aortic position. It is then deployed, either as a balloon-expandable valve or a self-expanding one, both of which are tissue valves that do not commit you to lifelong warfarin ¹.

This whole approach is not experimental: it rests on the PARTNER and Evolut trial programmes, and in contemporary practice the 30-day mortality for lower-risk patients is around 1 to 2% ⁴. During a balloon inflation the heart may be paced very fast for a few seconds to hold it steady, a brief odd flutter if you are awake. The team checks the valve is seated and sealing well before removing everything and closing the puncture.

Waking up and the first few hours

After the valve is in, you go to a recovery or coronary care area with a dressing over the groin and a heart monitor, not with a chest drain or a breastbone wound. You will usually be asked to lie fairly flat for a few hours to let the groin seal, then gradually sit and stand under supervision. Because nothing in your chest was cut, the recovery is counted in weeks rather than the months an open operation can take ².

I remember being wheeled back, thirsty, my leg heavy where they had pressed on it, and being faintly amazed that the breathlessness that had dogged me for a year was simply gone. By that evening I was sitting up with a cup of tea. What comes next, the discharge, the tablets, and getting back to normal, is its own subject: read what TAVR recovery is really like.

General information, not medical advice. Every TAVR is planned around your own scans, arteries, and health, and whether the procedure is right for you and how it is done are decisions for your own heart team.

References

2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease, American College of Cardiology / American Heart Association. ↩
TAVI (transcatheter aortic valve implantation), British Heart Foundation. ↩
Transcatheter Aortic Valve Replacement (TAVR), American Heart Association. ↩
Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients (PARTNER 3), New England Journal of Medicine. ↩

Common questions

Are you awake during a TAVR?

Often, yes. Many centres now do transfemoral TAVR under conscious sedation, so you are relaxed and pain free but breathing on your own, sometimes drowsy enough to doze through it. A general anaesthetic is still used where the anatomy, the access route, or your other conditions make it safer. Which one you have is decided in advance by the team, and it is a fair question to ask at your pre-admission visit.

How long does the TAVR procedure take?

The valve implant itself is usually quick, commonly around one to two hours in the catheter lab, though you will be in the room longer for the preparation, the local anaesthetic to the groin, and the checks at the end. Add time either side for admission, the recovery bay, and the wait until you can sit and then stand.

Where do they put the catheter in?

Almost always the femoral artery in the groin, the transfemoral route, because it gives a wide, direct path up to the heart. If those arteries are too narrow or calcified, the team can use an alternative access point, but the groin is the standard first choice and is why the soreness afterwards is in the leg.

Do they take the old valve out?

No. Unlike open surgery, TAVR leaves your diseased valve in place and expands the new one inside it, pushing the old leaflets aside. This is why the procedure can be done on a beating heart without a heart-lung machine, and it is one of the main reasons recovery is measured in weeks rather than months.

Will I feel the valve go in?

Most people do not feel the valve deploy. You may feel pushing or pressure at the groin, and the team may ask you to hold still or hold a breath at moments. During balloon inflation the heart is paced very fast for a few seconds, which some describe as a brief flutter. If you are under general anaesthetic you feel none of it.

What happens right after the valve is in?

The team removes the catheters and closes the groin puncture, often with a stitch-like closure device, then presses on the site. You go to a recovery or coronary care area, usually lie fairly flat for a few hours to protect the groin, and are monitored with a heart trace. Many people are sitting up and eating the same day.

Written by Diane Farrow. Medically reviewed by Dr. Helena Voss, MD, FESC.

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