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

BACKGROUND: In severe aortic stenosis with reduced left ventricular ejection fraction (LVEF), transcatheter aortic valve implantation (TAVI) improves systolic function. Self-expanding valves (SEV) show haemodynamic advantages over balloon-expandable valves (BEV), but whether this yields greater recovery of left ventricular function remains uncertain. OBJECTIVES: To compare change in ejection fraction between BEV and SEV in adults with LVEF < 40% undergoing TAVI, and to assess haemodynamics and clinical outcomes at 30 days and 12 months. METHODS: Observational cohort using a national registry of adults with LVEF < 40% and no prior myocardial infarction, coronary bypass, or more-than-moderate mitral regurgitation. Nearest-neighbor matching balanced annular perimeter, diameters, and calcification. Echocardiographic outcomes and major adverse cardiac and cerebrovascular events (MACCE) were assessed at 30 days and 12 months. Subgroup analyses stratified patients by annular perimeter ≤ 73.5 or > 73.5 mm. RESULTS: Of 922 patients, 574 received a BEV and 348 a SEV. Ejection fraction improved by 30 days and was maintained at 12 months, with no between-group difference. Haemodynamics favored SEV, with lower mean gradients at 30 days and 12 months (both p < 0.001). Clinical outcomes, including MACCE, were similar at 30 days and 12 months, and findings were consistent in small and large annulus strata. CONCLUSIONS: In patients with reduced LVEF, TAVI produced sustained improvement in ejection fraction irrespective of valve platform, and SEV conferred a haemodynamic advantage without differences in ejection fraction or clinical outcomes.