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Annular Ellipticity and Sizing Strategy in Transcatheter Aortic Valve Implantation: Independent or Combined Risk

Emre Polat¹, Lisa Müller¹, Lena Schemet^2,3

¹Department of Cardiothoracic Surgery, University Hospital Augsburg, Augsburg, Germany.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions

|March 2, 2026

Summary

Annular ellipticity did not predict adverse outcomes in TAVI. Moderate oversizing showed the best results, though high ellipticity combined with suboptimal sizing may reduce device success.

Keywords:

aortic valve aortic valve stenosis heart valve transcatheter aortic valve implantation

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Area of Science:

Cardiovascular Medicine
Interventional Cardiology
Medical Imaging

Background:

Elliptical annular anatomy is a potential risk factor for adverse outcomes, particularly paravalvular leakage (PVL), after transcatheter aortic valve implantation (TAVI).
The interplay between aortic annular shape and prosthesis sizing strategy requires further clarification.

Purpose of the Study:

To investigate the combined impact of aortic annular shape and prosthesis sizing on TAVI procedural success and short-term clinical outcomes.
To determine if annular ellipticity and sizing index influence device success and paravalvular leakage.

Main Methods:

Retrospective analysis of 509 patients undergoing TAVI.
Calculation of ellipticity index (EI) and sizing index (SI) from preprocedural CT scans.
Evaluation of device success, PVL, and other early safety endpoints.

Main Results:

Device success was achieved in 89% of patients, not significantly associated with EI.
Moderate oversizing (6%-15%) was linked to the highest success rates (93%).
PVL ≥ mild occurred less frequently with optimal oversizing (14%) compared to undersizing (30%), but no association with EI or SI was found.

Conclusions:

Aortic annular ellipticity alone does not predict adverse TAVI outcomes.
Exploratory analysis suggests potential for reduced device success with high ellipticity and suboptimal sizing, but no significant interaction was identified.
Moderate oversizing appears to be associated with the most favorable procedural outcomes in TAVI.