Self-Expanding or Balloon-Expandable TAVR with a Small Aortic Annulus

To the Editor: In their article on the Small Annuli Randomized to Evolut or SAPIEN Trial (SMART), Herrmann and colleagues (June 6 issue)¹ report the results of a head-to-head comparison of the self-expanding valve and the balloon-expendable valve in patients with aortic stenosis and a small aortic annulus (<430 mm2) who were undergoing transcatheter aortic-valve replacement (TAVR). Although the finding of no significant difference in clinical outcomes between these two valve platforms is reassuring, some caution is needed when interpreting the results. Although patients with a small aortic annulus represent up to 40% of the population of patients undergoing TAVR,...