Valve sizing in TAVR: avoiding over- and under-sizing
F Nascimento Ferreira, M Coelho, I Rodrigues, M Figueiredo, T Mendonca, R Ramos, A Fiarresga, R Cruz Ferreira, D CacelaAbstract
Introduction
Transcatheter aortic valve replacement (TAVR) has increasingly been adopted as a key treatment for severe aortic stenosis. As this technique has evolved, a growing number of valve models have been introduced. Among these, balloon-expandable valves have shown promising results in patients with complex or calcified anatomy. The range of valve sizes available has expanded, allowing a precise matching of prostheses to patient anatomy, ultimately enhancing procedural safety and efficacy.
Methods
Consecutive patients with severe aortic stenosis who underwent TAVR with balloon-expandable valves (Edwards Sapien) between 2019 and 2023 at a single centre were included. Two groups were defined based on whether the annulus area was compatible with Myval intermediate sizes (IS) or with regular sizes. Peri-procedural safety endpoints, technical success, intervention-related complications, 1-year mortality, and efficacy endpoints as defined by VARC-2 were assessed according to valve sizing. Statistical analysis was performed using the Chi-square test, Mann-Whitney U test, and independent samples t-test. A p-value < 0.05 was considered statistically significant.
Results
Of the 161 patients, 34 (21.1%) met the criteria for Myval intermediate sizes (IS). There were no significant differences between the two groups in terms of demographic characteristics (mean age 82 ± 7 years, 47,2% female). The group meeting criteria for IS had smaller valve perimeter and annulus area (74.5 ± 6.1 mm and 416 ± 69 mm², respectively). Regarding the procedure, the most frequently used valve was the Sapien 23mm. Absolute over/under-sizing was significantly higher in the IS group (18.1% [1.7 - 46.67] vs 9.5% [0.1 - 46.7], p<0.05). Although not statistically significant, there was a trend towards a higher rate of pacemaker implantation (32.4% vs 21.3%, p=0.168) and higher mean aortic valve gradients (18.1 mmHg [1.7 - 46.67] vs 9.5 mmHg [0.1 - 46.7]) after TAVR, with only one patient with significant paravalvular leak. There was no statistically significant difference in 1-year mortality between the groups.
Conclusion
Our study found no significant differences between the two groups regarding peri-procedural safety or technical success following TAVR with balloon-expandable. However, a trend was observed towards higher pacemaker implantation rates and higher mean AV gradients in patients with Myval intermediate size annulus area. These findings suggest that offering a broader range of valve sizes to accurately match the procedure to patient anatomy could influence long-term outcomes. Further studies with larger sample sizes are necessary to validate these trends.For image description, please refer to the figure legend and surrounding text.