August 2016 - NICE is updating this guidance (see the in development page for information). The NHS should continue to follow the recommendations in this guidance until the update is complete.

The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Trancatheter aortic valve implantation for aortic stenosis.

This document replaces previous guidance on Trancatheter aortic valve implantation for aortic stenosis (NICE interventional procedure guidance 266, June 2008).


Aortic stenosis occurs when the aortic valve, which separates the main pumping chamber of the heart from the circulation, becomes partially narrowed. This reduces the flow of blood out of the heart. Transcatheter aortic valve implantation may be an alternative to surgical valve replacement in patients for whom conventional aortic valve replacement is not suitable, or who at very high risk. The procedure is performed through a tube, which is usually inserted into a large blood vessel at the top of the leg or elsewhere (transluminal approach), but it is sometimes also inserted into the apex of the heart (transapical approach). Through this tube, a replacement valve is inserted and deployed over the faulty native valve.

Coding recommendations

Transluminal approach:

K26.2 Xenograft replacement of aortic valve

Y79.- Approach to organ through artery

Y53.- Approach to organ under image control

Note: Codes within category Y53.- are used as secondary codes to classify interventions that are percutaneous and require some form of image control: if the method of image control is unspecified, Y53.9 Unspecified approach to organ under image control is assigned.

 Transapical / transventricular approach:

K26.2 Xenograft replacement of aortic valve

Y49.4 Transapical approach to heart

The NHS Classifications Service has advised NICE that currently these are the most suitable OPCS-4 codes to describe this procedure. The OPCS-4 classification is designed to categorise procedures for analysis and it is not always possible to identify a procedure uniquely.

Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

  • National Institute for Health and Care Excellence (NICE)