Aortic Valve Replacement (AVR/TAVR) Abroad: 2025 Guide

AVR vs TAVR: Understanding Your Options

Aortic valve replacement is the definitive treatment for severe aortic valve disease, most commonly aortic stenosis — a progressive narrowing of the aortic valve that restricts blood flow from the heart to the body. Left untreated, severe symptomatic aortic stenosis carries a grim prognosis, with average survival of only two to three years after the onset of symptoms such as chest pain, fainting (syncope), and heart failure. Two fundamentally different approaches exist for replacing the diseased aortic valve: surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR, also known as TAVI). Understanding the differences between these approaches is essential for making an informed treatment decision.

Surgical aortic valve replacement (SAVR) is the traditional gold-standard approach that has been performed for over five decades with well-established long-term outcomes. The procedure involves a median sternotomy (opening the breastbone), placement on cardiopulmonary bypass (heart-lung machine), removal of the diseased native aortic valve, and implantation of a prosthetic valve — either mechanical or biological — that is sewn directly into the aortic valve annulus. SAVR allows the surgeon to completely remove the calcified native valve, directly visualize the anatomy, precisely size and position the prosthetic valve, and address any associated pathology such as ascending aortic aneurysm or concomitant coronary artery disease in the same operation.

Transcatheter aortic valve replacement (TAVR) is a revolutionary minimally invasive alternative that has transformed the treatment of aortic stenosis over the past fifteen years. Rather than opening the chest, the new valve is delivered through a catheter inserted into the femoral artery in the groin (transfemoral approach, used in over 95% of cases) and guided to the aortic position under fluoroscopic and echocardiographic guidance. The compressed valve is positioned within the diseased native valve and expanded, pushing the calcified leaflets aside and immediately restoring normal blood flow. TAVR avoids sternotomy, cardiopulmonary bypass, and general anesthesia in many cases, resulting in dramatically shorter hospital stays and faster recovery.

Who Is a Candidate for AVR/TAVR?

The decision between SAVR and TAVR depends on multiple patient-specific factors that are carefully evaluated by a multidisciplinary heart team consisting of cardiac surgeons, interventional cardiologists, cardiac anesthesiologists, and imaging specialists. Age is one of the most significant determinants — current guidelines generally favor TAVR for patients over seventy-five years of age and SAVR for patients under sixty-five, with a shared decision-making approach for patients in the intermediate age range of sixty-five to seventy-five. This age-based guidance reflects the proven longevity of surgical valves, the known but evolving durability data for TAVR devices, and the lower procedural risk of TAVR in older patients.

Surgical risk assessment plays a central role in determining candidacy. Patients who are considered high-risk or inoperable for traditional surgery — due to factors such as advanced age, frailty, severe lung disease, previous cardiac surgery, or porcelain (heavily calcified) aorta — are strong candidates for TAVR. The STS-PROM (Society of Thoracic Surgeons Predicted Risk of Mortality) score is widely used to stratify patients into low, intermediate, and high-risk categories. Landmark clinical trials have now established that TAVR is non-inferior or superior to SAVR across all risk categories for patients over sixty-five, significantly expanding the pool of patients who may benefit from the transcatheter approach.

• TAVR Preferred: Age >75, high surgical risk (STS >8%), previous cardiac surgery, severe frailty, porcelain aorta, severe lung or liver disease
• SAVR Preferred: Age <65, low surgical risk, bicuspid aortic valve (relative), need for concomitant surgery (bypass/other valve), endocarditis
• Shared Decision: Age 65-75, intermediate surgical risk, anatomy suitable for both approaches, patient preference and lifestyle considerations
• Contraindications to TAVR: Inadequate femoral artery access (though alternative access routes exist), severe aortic regurgitation without stenosis, active endocarditis

Anatomical considerations also influence the choice of approach. CT angiography of the heart and iliofemoral arteries is performed to assess the aortic annulus dimensions, degree of calcification, coronary artery height, and the adequacy of the femoral arteries for catheter delivery. Patients with bicuspid aortic valves (a congenital variant affecting approximately one to two percent of the population) have traditionally been considered better candidates for SAVR, though growing experience and newer TAVR devices have expanded the use of TAVR in selected bicuspid patients. Your heart team at the international hospital will review all imaging and clinical data to recommend the optimal approach for your individual case.

Cost Comparison by Country

The cost difference between SAVR and TAVR reflects the significant expense of the transcatheter valve device itself, which can add $10,000 to $30,000 to the procedure cost depending on the manufacturer and the country of treatment. In the United States, surgical aortic valve replacement costs between $80,000 and $200,000, while TAVR ranges from $120,000 to $350,000 — making it one of the most expensive cardiac procedures performed today. The higher cost of TAVR is partially offset by the shorter hospital stay and faster recovery, but the financial burden remains extraordinary for many patients, particularly those who are uninsured, underinsured, or face high-deductible insurance plans.

Aortic Valve Replacement Cost Comparison 2025

TAVR costs are higher due to the specialized catheter-delivered valve device ($10,000-$20,000 for the prosthesis alone). Prices include all hospital fees, prosthetic valve, and standard post-operative care.

Turkey has positioned itself as a leading destination for both surgical and transcatheter aortic valve replacement, with costs that represent exceptional value for the quality of care delivered. At Koc University Hospital, SAVR is available for $14,000 to $28,000 and TAVR for $25,000 to $50,000 — savings of up to 85% compared to US pricing. The hospital's structural heart program utilizes the latest generation TAVR devices from Edwards Lifesciences (SAPIEN 3 Ultra) and Medtronic (Evolut PRO+/FX), the same platforms used at leading US and European centers. Their hybrid operating room is equipped with state-of-the-art imaging including 3D transesophageal echocardiography and rotational angiography for precise valve sizing and deployment.

India offers the most affordable aortic valve replacement globally, with SAVR costs starting at just $8,000 and TAVR from approximately $20,000. Leading Indian cardiac centers including Medanta Heart Institute, Narayana Health, and Apollo Hospitals have extensive experience with both approaches and have contributed significantly to the global evidence base for TAVR. Thailand's Bumrungrad International and Bangkok Heart Hospital provide a premium experience with pricing in the mid-range, while South Korea's Samsung Medical Center and Seoul National University Hospital offer cutting-edge TAVR programs with the latest device platforms at prices well below Western levels.

TAVR has democratized aortic valve treatment. Patients who were once told they were too sick for surgery now have a safe, effective treatment option that can restore their quality of life with minimal recovery time.

Dr. Martin Leon, Director of the Center for Interventional Vascular Therapy

Best Countries for TAVR

Not all international hospitals are equally equipped to perform TAVR, as this specialized procedure requires specific infrastructure, device inventory, and multidisciplinary expertise that go beyond what is needed for standard cardiac surgery. When evaluating countries and hospitals for TAVR abroad, patients should prioritize facilities that have a dedicated structural heart disease program, a hybrid operating room with advanced fluoroscopy and echocardiographic imaging, access to multiple TAVR device platforms (allowing the team to select the optimal device for each patient's anatomy), and a comprehensive heart team with proven TAVR experience including both transfemoral and alternative access approaches.

Turkey stands out as an excellent destination for TAVR, with multiple hospitals in Istanbul offering mature structural heart programs. American Hospital Istanbul has performed hundreds of TAVR procedures and maintains a comprehensive valve program staffed by interventional cardiologists with training at leading European and American centers. The hospital offers both Edwards SAPIEN and Medtronic Evolut device platforms, ensuring that each patient receives the optimal valve for their specific anatomy. Their international patient coordinators provide end-to-end support including pre-arrival CT scan review, visa assistance, luxury accommodation arrangements, and coordinated post-discharge follow-up.

South Korea has emerged as a technology leader in structural heart interventions, with centers like Asan Medical Center and Samsung Medical Center performing high volumes of TAVR with excellent outcomes. These hospitals are early adopters of the newest TAVR technology and participate in international clinical trials, giving patients access to the latest advances in valve design and delivery systems. Malaysia's National Heart Institute (IJN) and India's Medanta Heart Institute also maintain strong TAVR programs with competitive pricing, making aortic valve replacement accessible to patients across a wide range of budgets. The choice of destination ultimately depends on the patient's specific medical needs, budget constraints, travel preferences, and the recommendations of their local cardiologist.

Recovery Timeline

The recovery experience differs dramatically between surgical AVR and TAVR, and this difference is one of the primary factors driving the expansion of TAVR to lower-risk patient populations. After surgical AVR (SAVR), the recovery pathway mirrors that of other open-heart surgeries: one to three days in the cardiac ICU, followed by four to seven days on the cardiac ward, with sternal precautions enforced for six to eight weeks. Patients can typically return to light work within four to six weeks and resume full physical activities by eight to twelve weeks, subject to surgical clearance. The total recovery period is comparable to coronary bypass surgery and requires patience, gradually progressive rehabilitation, and careful wound management.

TAVR recovery is remarkably rapid compared to surgical AVR. Most TAVR patients are ambulatory within hours of the procedure and are discharged from the hospital within one to three days. Because there is no sternotomy, no cardiopulmonary bypass, and minimal general anesthesia (many TAVR procedures are performed under conscious sedation), the physical recovery is dramatically easier. The primary recovery focus after TAVR is healing the catheter insertion site in the groin, which typically requires only a few days of precautions against heavy lifting and strenuous activity. Many TAVR patients return to their normal daily routines within one week and can travel by air within seven to fourteen days.

• SAVR Recovery: ICU 1-3 days, hospital total 7-10 days, sternal healing 6-8 weeks, full recovery 8-12 weeks, fly home 2-3 weeks post-op
• TAVR Recovery: Hospital 1-3 days, groin site healing 3-5 days, return to activities 1-2 weeks, fly home 7-14 days post-op
• Medications After SAVR: Anticoagulation (warfarin for mechanical valve, or aspirin for biological), statins, blood pressure medications
• Medications After TAVR: Dual antiplatelet therapy (aspirin + clopidogrel) for 3-6 months, then aspirin alone, statins as indicated
• Follow-up: Echocardiogram before discharge, at 30 days, and annually; earlier if symptoms develop
• Cardiac Rehabilitation: Recommended for both SAVR and TAVR; structured exercise program for 6-12 weeks improves functional outcomes

Choosing the Right Approach

The decision between SAVR and TAVR should be made collaboratively between the patient and a multidisciplinary heart team, taking into account all relevant clinical, anatomical, and personal factors. While the trend in aortic valve treatment is clearly moving toward TAVR for an increasing proportion of patients, surgical AVR remains the preferred approach in several important clinical scenarios. Young patients under sixty-five generally benefit from SAVR because the long-term durability of surgical valves is better established, and these patients may outlive a TAVR device. Patients needing concomitant cardiac surgery — such as coronary bypass, mitral valve repair, or aortic aneurysm repair — are also better served by SAVR, as these additional procedures can be performed during the same operation.

For patients considering treatment abroad, the choice of approach may also be influenced by the expertise available at different international hospitals. While virtually all cardiac surgery centers can perform SAVR, TAVR requires specialized equipment, device inventory, and interventional expertise that may not be available at every hospital. Patients interested in TAVR should specifically verify that their chosen hospital has an active structural heart program with a track record of at least one hundred TAVR procedures and that the heart team includes both experienced interventional cardiologists and cardiac surgeons. At Liv Hospital Istanbul, both approaches are available within the same cardiovascular center, allowing the heart team to recommend and perform whichever approach is most appropriate for each individual patient without the bias of limited capabilities.

Ultimately, the best approach is the one that provides the lowest risk of complications, the longest valve durability appropriate for the patient's life expectancy, the fastest recovery compatible with the patient's goals, and the most predictable long-term outcomes based on the patient's specific anatomy and clinical profile. Seeking opinions from multiple cardiac centers — both at home and abroad — can help ensure that the recommendation you receive is truly in your best interest and not influenced by institutional capabilities or financial incentives.

Frequently Asked Questions