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Self-expanding TAVR valve helps patients with small aortic annuli
The SMART trial's 3-year results showed that self-expanding supra-annular TAVR valves (Evolut platform, Medtronic) demonstrated superior hemodynamics and less thrombosis compared to balloon-expandable valves (Sapien platform, Edwards Lifesciences) in patients with small aortic annuli (≤430 mm²). There was no difference in the composite clinical endpoint of mortality, disabling stroke, or heart failure rehospitalization between groups (self-expanding 25.4% vs balloon-expandable 22.6%; HR 1.13, 95% CI 0.83-1.53, P=0.44).
Digest: These extended follow-up data support the use of self-expanding supra-annular valves for improved hemodynamic performance in small annuli patients, particularly relevant for lower-risk and younger TAVR candidates where long-term valve function is critical.