The SMART trial compared self-expanding and balloon-expandable valves in patients with small aortic annuli undergoing TAVR. The study showed that self-expanding valves had better hemodynamic results at 1 year, with no difference in clinical outcomes. The trial, which enrolled primarily women, found that the self-expanding valve had lower rates of bioprosthetic valve dysfunction compared to the balloon-expandable valve. While there was no significant difference in pacemaker implantation rates between the two valves, the self-expanding valve was associated with less aortic insufficiency and better quality of life scores. These findings suggest that self-expanding valves may be a better option for patients, particularly women, with small aortic annuli.
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In small aortic annuli, self-expanding TAVR valve may be preferred for hemodynamics
