(P097) SMART TRIAL IN ACTION: EVALUATING POST-TAVI OUTCOMES WITH BALLOON AND SELF EXPANDING VALVES IN PATIENTS WITH SMALL AORTIC ANNULUS

Background: As the indication for Transcatheter Aortic Valve Implantation (TAVI) expands to the low-risk population, optimizing outcomes using balloon-expanding (BEV) and self-expanding valves (SEV) has become crucial. Prior to the publication of the SMART trial, the implementation of SMART-like practices was intended to improve outcomes using SEV for small aortic annuli.

METHODS AND RESULTS: In this single-center, retrospective observational cohort study, data from the QEII TAVI registry were analyzed (2012 to 2024). Since 2021, both valve types have been available, with valve selection based on specific patient indications, primarily using SEV for patients with small annuli. The study included all patients with aortic annuli < 430mm² undergoing TAVI, focusing on outcomes following the early adoption of SMART-like practices.

The study comprised 295 patients (31% of the total TAVI cohort) with 79.7% female. Age and STS scores were lower in the post-SMART group (79.3 years and 4.8) compared to pre-SMART (82 years and 6.4). SEV use increased from 45% pre-SMART to 79.2% post-SMART. Pacemaker implantation rates remained stable (8.2% pre-SMART, 8.7% post-SMART). High gradients (>20 mmHg) decreased from 6.2% pre-SMART to 1.3% post-SMART (P=0.029), and mean gradients improved from 11.2 mmHg to 9.8 mmHg (P=0.019). Paravalvular leak rates showed no significant change (4.8% pre-SMART vs. 2.7% post-SMART).

Conclusion: The early implementation of SMART-like practices significantly increased the use of SEV over BEV, leading to immediate improvements in postoperative hemodynamic gradients. This shift has shown beneficial effects in clinical practice settings, although further analysis is needed to explore long-term outcomes and valve deterioration.