S mall aortic annulus (SAA) is still a challenge in bothsurgical aortic valve replacement (SAVR) and transcatheteraortic valve replacement (TAVR) for aorticstenosis (AS) patients. SAA has been shown to be associatedwith poorer outcomes after SAVR, with increasedmortality and ischemic cardiovascular events, comparedwith normal-sized aortic annulus.1 SAA has been knownto cause prosthesis-patient mismatch (PPM), which is associatedwith less left ventricular (LV) mass regression,increased heart failure rehospitalization, structural valvedeterioration, and late mortalities after AVR.2 In this issueof the Journal, Meguro et al report several important findingsregarding TAVR for AS patients with SAA based onan analysis of data from the Japan Transcatheter ValveTherapies registry.
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