Surgical aortic valve replacement carries a potential risk of abnormally high post-operative gradients especially in patients with severe AS and small aortic annulus size.20,21 One study demonstrated that the mean post-procedural transprosthetic gradient was significantly lower in the balloon expandable TAVI cohort compared with surgical aortic valve replacement.22 According to the authors’ findings, distention of the aortic annulus due to systematic oversizing and the absence of a sewing ring may have been the potential mechanisms accounting for the superior haemodynamic profile associated with TAVI compared with standard surgical valves. In patients with smaller body and smaller annulus size, TAVI may have a potential benefit of avoidance of abnormally high post-operative gradients.23
TAVI for patients with smaller anatomy is challenging in terms of specific anatomical difficulty and complications. In order to avoid these serious complications, meticulous annulus measurement,8 evaluation of calcification distribution on the aortic annulus24 and pre-screening of ilio-femoral access12 are of great importance. In addition to these pre-screening efforts, the prevalence of newer-generation and lowerprofile TAVI systems will surely provide safe TAVIs for patients with smaller anatomy.