Incidence, Implications, and Treatment of Patients With Severe Aortic Stenosis and Small Aortic Annulus

Abstract

A small aortic annulus (SAA) has been variably defined based on the computed tomography scan aortic annular area (≤400-430 mm 2 ) or surgical prosthesis diameter (≤21 mm). The reported incidence of SAA in patients with severe aortic stenosis is up to 40% in contemporary studies, and the great majority of these patients are women. [1][2][3] Patients with a SAA who receive a small aortic valve replacement prosthesis are at risk for high residual gradients and prosthesis-patient mismatch (PPM), which in turn are associated with major adverse cardiovascular events, including mortality. 4 Last, patients with a small prosthesis who require repeat procedures are at higher risk for sinus sequestration, coronary obstruction, and mortality with repeat procedures (transcatheter aortic valve replacement [TAVR] in TAVR, TAVR in surgical aortic valve replacement [SAVR], and TAVR explant).