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Introduction Aortic stenosis (AS) is predominantly a disease of ageing, with a prevalence exceeding 10% in those over 75 years. Transcatheter aortic valve implantation (TAVI) is the primary treatment modality in elderly patients. Frailty and related geriatric syndromes are common in the elderly and are associated with increased peri-procedural complications, reduced functional recovery, impaired quality of life and increased mortality following TAVI. Accordingly, guidelines recommend routine frailty assessment to aid patient selection and identify modifiable targets for pre-procedural optimisation. To support this, and to prevent and manage common post-procedural complications such as delirium and hospital-acquired disability, geriatrician involvement within the valve multidisciplinary team (MDT) and wider service is recommended.Methods We designed and conducted a survey of all 34 UK NHS TAVI centres to evaluate current models of geriatrician involvement and identify opportunities for pathway and workforce innovation.Results Responses were received from 27/34 (79%) centres. Only 6/27 (22%) centres routinely included a geriatrician within the valve MDT, while 7/27 (26%) centres had a linked geriatrician-led pre-assessment service (e.g. to aid patient selection or pre-procedural optimisation in selected patients). Patients discussed at valve MDT routinely had their frailty status recorded in 16/27 (59%) centres. Clinical Frailty Scale (CFS) was the preferred assessment tool in all of these centres, with five centres routinely using additional tools (e.g. Katz Index of Independence in Activities of Daily Living (ADL), Essential Frailty Toolset (EFT)). Access to inpatient geriatric liaison/shared care post-procedure was available in 10/27 (37%) centres.Discussion Geriatrician involvement in UK TAVI pathways remains limited with wide variation between centres. Limited peri-procedural geriatric expertise may reduce opportunities for holistic patient selection, shared decision-making, pre-procedural optimisation and prevention of functional decline. Hypothesised barriers to geriatrician involvement include geriatric workforce constraints, lack of protected MDT time and variable commissioning of geriatric services. Potential solutions include development of standardised national pathways, wider use of pragmatic frailty tools, and alternative models of care such as sessional or virtual geriatrician MDT input. Enhanced workforce planning and greater emphasis on frailty, multimorbidity and geriatric syndromes within cardiology training may also help bridge this gap and improve equity and quality of care for older adults undergoing TAVI.