Oversizing Transcatheter Aortic Valves: Are We Getting It Right?

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Devices

Background:

• Optimal valve sizing is critical for successful transcatheter aortic valve replacement (TAVR).
• Oversizing the transcatheter heart valve impacts patient outcomes and procedural success.

Purpose of the Study:

• To evaluate the association between different degrees of transcatheter aortic valve oversizing and patient outcomes after TAVR.
• To determine if moderate oversizing (10-20%) is associated with improved mortality or complications.

Main Methods:

• Retrospective analysis of 1,808 patients undergoing TAVR from 2010-2025.
• Patients categorized into minimal (<10%), moderate (10-20%), and severe (≥20%) oversizing groups.
• Multivariable analysis used to assess outcomes including all-cause mortality and early complications.

Main Results:

• No significant differences in early outcomes (e.g., stroke, pacemaker implantation) across oversizing groups.
• Moderate oversizing (10-20%) was independently associated with lower all-cause mortality (HR=0.63; p=0.02).
• Severe oversizing (≥20%) showed no significant difference in all-cause mortality compared to minimal oversizing.

Conclusions:

• A moderate oversizing range of 10-20% for transcatheter aortic valves is associated with reduced all-cause mortality.
• This moderate oversizing range did not increase early procedural complications or paravalvular leak.
• Findings suggest a potential benefit of moderate oversizing in TAVR for long-term survival.