Moderate valve oversizing during TAVR boosts survival—too much may be less beneficial
Moderate valve oversizing during transcatheter aortic valve replacement (TAVR) procedures is associated with improved survival, according to a new analysis published in The American Journal of Cardiology.[1]
“Optimal valve sizing ensures secure anchoring of the transcatheter heart valve, while minimizing complications such as paravalvular leak (PVL), annulus rupture and conduction disturbances,” wrote first author Takuya Ogami, MD, a researcher with the department of cardiothoracic surgery at the University of Pittsburgh and UPMC Heart and Vascular Institute, and colleagues. “Despite this shared objective, clinical practice varies widely. Historically, some operators were strong proponents of aggressive oversizing to minimize PVL, whereas others adopted a more conservative approach to avoid the potential complications associated with oversizing, such as conduction disturbance or annual rupture. These divergent clinical philosophies, rooted in earlier device iterations, are now being reevaluated as contemporary transcatheter heart valve designs enable more precise, anatomy conforming implantation.”
Ogami et al. reviewed data from more than 1,800 TAVR patients who underwent treatment at a high-volume U.S. facility from 2020 to 2025. The mean age was 80 years old. Patients were categorized based on the amount of oversizing that occurred—minimal (less than 10%), moderate (10% to 20%) or severe oversizing (20% or more).
Overall, minimal oversizing occurred in 10% of patients, moderate oversizing occurred in 24% of patients and severe oversizing occurred the other 66%. The median age was slightly lower in the moderate oversizing group than in the other two groups. In addition, Society of Thoracic Surgery risk scores were comparable between all three groups.
The researchers found that moderate oversizing was independently associated with a reduced risk of all-cause mortality after TAVR. This same benefit was not seen with minimal and severe oversizing. Procedural outcomes were comparable for the three groups. PVL was rare for all groups and “did not differ significantly” from one oversizing approach to the next.
Ogami and colleagues did note that prior research has suggested “excessive oversizing” may increase certain risks when patients receive a balloon-expandable valve. Perhaps because of this known trend, the group found that balloon-expandable valves most commonly landed in the minimal oversizing group. In general, the group emphasized that moderate oversizing appears to be the best path forward during TAVR.
The American College of Cardiology, meanwhile, recommends “a small degree of oversizing” to optimize implant outcomes and minimize the risk of PVL.
“Although severe oversizing did not increase mortality in this cohort, it should be approached with caution with balloon-expandable valves,” the authors wrote. “These results complement existing guidelines and multicenter data, emphasizing that oversizing strategies should be individualized according to valve type, annular measurements, and patient risk profile to optimize both procedural success and long-term outcomes.”
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Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.