Why is this study important?

• Optimal treatment strategy for patients with severe aortic stenosis (AS) and small aortic annulus remains unclear. 
• Observational studies suggest that this subgroup is at risk of patient-prosthesis mismatch (PPM), and transcatheter aortic valve replacement (TAVR) may offer superior performance as compared to surgical aortic valve replacement (SAVR).
• This anatomic subset is common among women and often under-represented in large-scale randomized controlled trials (RCT). 

What question was this study supposed to answer?

• To compare hemodynamics and clinical outcomes between TAVR and SAVR among severe AS patients with small aortic annulus.

What did the study show?

• 151 low-intermediate risk patients with small aortic annulus (mean diameter <23 mm) were randomized to TAVR or SAVR; 93% were women.
• In the TAVR arm, a self-expanding platform was used in 59.2% of patients, and a balloon-expandable platform in 40.8% of patients. The median valve size was 23 mm in the TAVR arm and 21 mm in the SAVR arm.
• The rate of severe PPM at 60 days was not significantly different between TAVR and SAVR (5.6% vs. 10.3%, p= 0.30).
• There was no difference in mortality (1.3% vs. 1.4%) and stroke (0 vs. 2.7%) between TAVR and SAVR at 30 days. These findings were consistent at a two-year follow-up.
• Thus, contemporary TAVR and SAVR offered similar hemodynamic and clinical outcomes in this selected patient group.