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Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.

Transcatheter and surgical valve intervention

Cardiology · UK scope · Sources checked 27 Aug 2026 · Clinical review pending

RapidFull
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Escalate

Acute severe mitral or aortic regurgitation with pulmonary oedema or shock, an obstructed prosthesis, or decompensated critical stenosis requires monitored admission and immediate surgical/structural Heart Team assessment; stabilisation must not delay definitive intervention.

Synopsis

Match lesion, timing, anatomy and patient goals to the safest durable valve intervention through a Heart Team.

  • Symptoms, ventricular response and lesion severity drive intervention; age alone never establishes an indication.
  • For severe aortic stenosis, NICE favours SAVR in people under 75 who are low surgical risk and TAVI in people 75 or older or at high surgical risk when both are suitable; anatomy, life expectancy and preference can change the choice.
  • TAVI is offered when surgery is unsuitable and transfemoral anatomy is feasible; surgery remains important for bicuspid anatomy, aortopathy, endocarditis or disease needing concomitant CABG/other valve repair.
  • Durable surgical mitral repair is preferred over replacement for suitable severe primary mitral regurgitation.
  • Mitral transcatheter edge-to-edge repair (TEER) is an option for symptomatic severe primary MR when surgery is unsuitable and anatomy is suitable; secondary MR requires optimised HF therapy and specialist selection.
  • Transcatheter tricuspid intervention is anatomy- and centre-dependent; NICE procedural governance and a specialist Heart Team are required.
  • The intervention decision must include frailty, cognition, renal/lung disease, rehabilitation potential, expected survival, durability, pacemaker risk, access route and the person's priorities.
  • A technically successful procedure still needs baseline imaging, antithrombotic planning, endocarditis advice and lifelong surveillance.

Key red flags

Symptomatic severe stenosis

Exertional breathlessness, angina, presyncope/syncope or heart failure with severe valve obstruction warrants prompt intervention review.

Acute regurgitation

Pulmonary oedema or shock after papillary-muscle/chordal rupture, endocarditis or aortic dissection needs emergency surgical/structural assessment.

Investigation priorities

01
Comprehensive TTEFirst step

Confirm mechanism/severity and ventricular, pulmonary-pressure and multivalve consequences.

Management branches

ASSevere aortic stenosis

Symptoms or another guideline trigger for valve replacement after severity is confirmed.

  1. Exclude a reversible high-flow or measurement explanation and document symptom/ventricular trigger.
  2. If surgery is unsuitable and transfemoral anatomy is suitable, offer TAVI; if TAVI is technically unsuitable, discuss alternative access versus palliation.
  3. If both are suitable, generally favour SAVR below 75 at low surgical risk and TAVI at 75 or above or high surgical risk, then modify for anatomy, durability, concomitant disease and preference.
  4. Choose SAVR when endocarditis, aortic surgery, complex CABG, another surgical valve procedure or anatomy unsuited to safe TAVI is present.

Key medicines

Aspirin after TAVI75 mg by mouth once daily when there is no separate indication for oral anticoagulation; use clopidogrel 75 mg once daily if aspirin is not tolerated.Do not add routine oral anticoagulation or dual antiplatelet therapy solely for TAVI; reconcile recent PCI and bleeding risk.
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Sources and review status5 sources · checked 27 Aug 2026 · clinical review pending+
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

  • NICE NG208: Heart valve disease presenting in adultsUK TAVI/SAVR and mitral intervention choices.
  • 2025 ESC/EACTS valvular heart disease guidelineCurrent Heart Team, imaging and transcatheter/surgical framework.
  • NICE HTG518: Transcatheter aortic valve implantationUK procedural governance for TAVI.
  • NICE IPG731: Transcatheter tricuspid leaflet repairUK evidence/governance for tricuspid intervention.
  • NHS: Heart valve diseaseUK patient-facing recognition and treatment context.

Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom