Oversizing Transcatheter Aortic Valves: Are We Getting It Right?

Optimal valve sizing is critical in transcatheter aortic valve replacement (TAVR) to minimize complications and provide the best clinical and hemodynamic results. The objective of this study was to evaluate whether increasing degrees of transcatheter aortic valve oversizing are associated with differences in patient outcomes following TAVR. A retrospective analysis was conducted to identify patients who underwent TAVR from 2010 to 2025 using our institutional registry. Oversizing was defined as the ratio of the implanted transcatheter heart valve size to the preprocedural annular diameter. Patients were split into 3 groups: minimal oversizing (<10% oversize), moderate oversizing (10% to <20%), and severe oversizing (≥20%). A total of 1,808 patients were included: 180 (10%) in the minimal oversizing group, 433 (24%) in the moderate oversizing group, and 1,195 (66%) in the severe oversizing group. The mean age across groups was 80.0 ± 7.2 years. There were no statistically significant differences in early outcomes, such as valve implantation success rates, postoperative stroke incidence, or new pacemaker implantation among the groups. However, a multivariable analysis demonstrated that the moderate oversizing group was independently associated with a lower all-cause mortality (hazard ratio = 0.63, 95% CI 0.43 to 0.89; p = 0.02), while severe oversizing had equivalent (hazard ratio = 0.82, 95% CI 0.52 to 1.25; p = 0.35). The incidence of paravalvular leak at 1 year and follow-up aortic valve reintervention rates were similar across groups. An oversizing range of 10% to 20% during TAVR was associated with lower all-cause mortality without an accompanying increase in early procedural complications.