The miracle of left ventricular recovery after transcatheter aortic valve implantation

In this issue of EuroIntervention, Witberg et al1 analyse data from the AMTRAC Registry to examine the incidence, predictors and outcomes of left ventricular (LV) recovery post-transcatheter aortic valve implantation (TAVI). Of 10,872 TAVI patients included in this 17-centre registry from Europe and Israel, 914 had severe LV dysfunction prior to TAVI (LV ejection fraction [LVEF] ≤30%). LVEF recovered by ≥10% in 59.5% of patients and normalised to ≥50% in approximately one-quarter of patients. Compared to patients with a baseline LVEF >30%, no LV recovery was associated with increased mortality, LV recovery with similar mortality, and LV normalisation with lower mortality at 3 years. The miraculous nature of these results deserves further examination.

While it may seem obvious that unloading the ventricle with an aortic intervention would lead to early imprÂoÂvÂeÂÂÂÂÂments in LV systolic function, these findings should not be taken for granted. For example, it also seems obvious that revascularisation of multivessel coronary artery disease (CAD) should improve LV systolic function in patients with ischaemic cardiomyopathy. Yet, revascularisation with either percutaneous coronary intervention (PCI) or coronary artery bypass...