EuroPCR 2026 – Prof Howard Herrmann (University of Pennsylvania School of Medicine, Philadelphia, PA, US) joins us to discuss three-year outcomes from the SMART trial, evaluating self-expanding versus balloon-expandable transcatheter aortic valve replacement in patients with a small aortic annulus and symptomatic severe native aortic stenosis.

This prospective, international, randomised controlled trial enrolled 1,103 patients across 92 sites, randomising them 1:1 to receive TAVR with either the Medtronic Evolut PRO/PRO+/FX self-expanding system or the Edwards SAPIEN 3/3 Ultra balloon-expandable system. The trial was designed to demonstrate clinical non-inferiority and haemodynamic superiority of the self-expanding valve at 12 months, with extended follow-up assessing durability and longer-term clinical outcomes in this anatomically challenging population.

Interview Questions: 

1. Why does a small aortic annulus present specific challenges for TAVR, and why does valve selection matter?
2. What were the primary objectives of the SMART trial and how was it designed?
3. What did the 12-month data show, and what questions remained unanswered?
4. What are the headline findings from the three-year analysis?
5. How have the haemodynamic profiles of both valve systems held up over three years?
6. How should these findings inform valve selection in small annulus patients?
7. What are your key take-home messages from the three-year SMART data?

Recorded on-site at EuroPCR 2026, Paris.
Editors: Jordan Rance
Videographer: Dan Brent
Support: This is an independent interview produced by Radcliffe Cardiology.