TAVI is recommended in high-risk patients or those with contraindications for surgery. Risk evaluation is usually performed using the Logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) and/or the Society of Thoracic Surgeons (STS) Predicted Risk of Mortality Score. High surgical risk is defined by a logistic EuroSCORE of ≥15-20% or an STS mortality risk score of ≥10%.

Patient characteristics that might favor TAVI over AVR include prior cardiac surgery with grafts and/or adhesions, previous chest radiation therapy, porcelain aorta, liver cirrhosis, pulmonary hypertension, right ventricular failure or marked patient frailty.

TAVI is not recommended for patients whose life expectancy is less than one year or who cannot expect significant improvement in quality of life.