# Case Report: A case of transcatheter aortic valve replacement in a patient with a small aortic annulus using the Acurate Neo2

## TL;DR

An 80-year-old woman with a small aortic annulus successfully underwent TAVR using the Acurate Neo2 valve, demonstrating its potential in challenging cases.

## Contribution

The off-label use of Acurate Neo2 in one of the smallest aortic annuli reported, particularly in Asian and resource-limited settings.

## Key findings

- TAVR with Acurate Neo2 was feasible in a patient with a severely calcified small aortic annulus.
- The patient had a successful outcome without major complications despite multiple risk factors for PPM.
- The case highlights the potential of Acurate Neo2 in challenging anatomical scenarios.

## Abstract

Small aortic annulus poses a major challenge in aortic valve replacement due to the increased risk of prosthesis–patient mismatch (PPM) and increased surgical risk. In recent years, transcatheter aortic valve replacement (TAVR) has emerged as a popular alternative to the traditional surgical aortic valve replacement. We present the case of an 80-year-old woman with a small aortic annulus who underwent TAVR using a self-expanding transcatheter heart valve Acurate Neo2 after an non-ST-segment elevation myocardial infarction (NSTEMI) presentation. These risks, combined with advanced age, significant co-morbidities, and a severely calcified small aortic annulus, supported the choice of TAVR with a self-expanding Acurate Neo2 valve. Despite multiple risk factors for PPM, the patient had a successful outcome without major complications. Our case highlights the off-label use of the Acurate Neo2 valve in one of the smallest aortic annuli reported to date, showcasing its feasibility in Asian and resource-limited settings.