ACC.24 — Investigator, Dr Howard C Hermann (Penn Medicine, Philadelphia, PA, US) joins us to discuss the findings from the SMART Trial (NCT04722250).
This prospective, multi-center, randomized controlled study aims to investigate the valve safety and performance of self expanding as compared to balloon-expandable transcatheter aortic valve replacement (TAVR) in patients with small aortic annuli and severe symptomatic aortic stenosis. At select sites, a stress echocardiography sub-study also evaluated the performance of self expandable and balloon-expandable TAVR in this patient group, after exercise stress testing.
716 patients were enrolled in the trial, and were randomized on a 1:1 basis to receive TAVR with either a Medtronic self-expanding transcatheter aortic valve, or an Edwards balloon-expandable transcatheter heart valve.
Findings showed that the trial met both primary endpoints, with no significant difference between groups in terms of a composite of death, disabling stroke or rehospitalization for heart failure, which occurred in 9.5% of patients with the self-expandable valve, and 10.6 of those with the balloon-expandable valve. In terms of valve function, the self-expandable valve was found to be superior in a composite of structural and non-structural valve deterioration, blood clotting around the valve, infection of the valve and aortic valve reintervention.
Interview Questions:
- What is the importance of this study?
- Could you tell us a bit more about the devices used in this study, and why SE and BE devices are compared in this patient group?
- What are the key findings?
- What is the impact of these findings on clinical practice?
- What is your take-home message?
- What further research is required?
Recorded onsite at the ACC Conference in Atlanta, 2024.
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Support: This is an independent interview conducted by Radcliffe Cardiology.
Editors: Jordan Rance, Mirjam Boros
Video Specialists: Dan Brent, Tom Green, Mike Knight
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