Balloon Versus Self-Expandable TAVI in Patients With Left Ventricular Dysfunction: A Real-World Comparative Study.

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Medical Devices

Background:

• Severe aortic stenosis with reduced left ventricular ejection fraction (LVEF) impacts systolic function.
• Transcatheter aortic valve implantation (TAVI) is a treatment option for these patients.
• Self-expanding valves (SEV) may offer hemodynamic advantages over balloon-expandable valves (BEV), but their impact on LVEF recovery is unclear.

Purpose of the Study:

• To compare changes in ejection fraction between BEV and SEV in TAVI patients with LVEF < 40%.
• To assess hemodynamic performance and clinical outcomes at 30 days and 12 months post-TAVI.
• To investigate subgroup differences based on annular perimeter.

Main Methods:

• Observational cohort study using a national registry.
• Included adults with LVEF < 40% and specific exclusion criteria.
• Nearest-neighbor matching used to balance patient characteristics; echocardiographic and clinical outcomes (MACCE) assessed at 30 days and 12 months.

Main Results:

• Ejection fraction improved by 30 days and was sustained at 12 months, with no significant difference between BEV and SEV groups.
• SEV demonstrated superior hemodynamics with lower mean gradients at both time points (p < 0.001).
• Major adverse cardiac and cerebrovascular events (MACCE) were similar between groups at 30 days and 12 months, consistent across annulus size subgroups.

Conclusions:

• TAVI leads to sustained improvement in ejection fraction in patients with reduced LVEF, irrespective of the valve platform used.
• While SEV provide a hemodynamic advantage, they do not result in differential recovery of ejection fraction or improved clinical outcomes compared to BEV.
• The choice between BEV and SEV in this patient population does not appear to impact long-term functional recovery or clinical events.