Clinical Impact of Prosthesis Oversizing in Self-Expanding Intra-Annular Transcatheter Aortic Valve Replacement

Among patients undergoing transcatheter aortic valve replacement (TAVR), valve sizing is essential to guarantee procedural success and long-term durability of transcatheter heart valves (THVs). The optimal sizing strategy for self-expanding (SE) intra-annular THVs remains unclear. The aim of this study is to evaluate the impact of prosthesis oversizing on procedural and clinical outcomes in patients undergoing TAVR with the Portico and Navitor THVs.

This retrospective, multicenter study included patients who underwent TAVR with SE intra-annular THVs between October 2017 and September 2024. Patients were stratified by the median oversizing value (14%) into low- (≤14%) and high- (>14%) oversizing groups. The primary endpoint was technical success. Secondary outcomes included 30-day device success, permanent pacemaker implantation, cardiovascular mortality, heart failure-related hospitalization, and valve dysfunction at 12 months.

A total of 400 patients (mean age 83.0 ​± ​6.0 years; 65.8% female) were included. Technical success was higher in the low-oversizing group (96.7 vs. 92.1%; p ​= ​0.048). Valve embolization occurred only in the high-oversizing group (0 vs. 2.1%; p ​= ​0.035). No significant differences were observed in 30-day device success (93.0 vs. 88.3%; p ​= ​0.171) and moderate-to-severe paravalvular regurgitation (2.9 vs. 1.8%; p ​= ​0.724). No differences emerged in permanent pacemaker implantation rates (24.5 vs. 25.7%; p ​= ​0.712). At 12 months, cardiovascular mortality (4.6 vs. 4.9%; p = 0.884) and heart failure hospitalization rates (6.9 vs. 4.9%; p = ​0.497) were similar.

In patients undergoing TAVR with SE intra-annular THVs, low-oversizing (≤14%) was associated with higher technical success and fewer valve-related complications.