Short and Long-Term Outcomes of Transcatheter Aortic Valve Implantation in the Small Aortic Annulus: A Systematic Literature Review.

Transcatheter aortic valve implantation has revolutionized the treatment of aortic stenosis. The small aortic annulus is one of the most challenging aspects of aortic stenosis treatment and since the beginning, TAVI has shown promising results in this subgroup of patients. This systematic literature review aims to investigate the short and long-term outcomes of TAVI in the small aortic annulus. The literature was meticulously screened for this topic until April 2024 using the PRISMA guidelines. Technical aspects, characteristics of this subgroup of patients, hemodynamic performances, and outcomes are discussed. The importance of device selection has shown up, with insight into the differences between self-expandable and the balloon-expandable valves. Two special populations were also taken into account: outcomes of TAVI in the small aortic annulus with bicuspid aortic valve and extra-small aortic annulus. The last 10 years have been paramount in technological advancements, bringing TAVI to broader use in this population. While several important trials underscored the usefulness of TAVI in the small aortic annulus population, the clinical practice still lacks consensus on the ideal device, and the outcomes are debated. The pivotal role of TAVI in this context needs to be addressed with a patient-tailored approach to optimize patient care.