Oversizing strategies to avoid post-procedural aortic leak following TAVI are developing. The purpose of the study was to investigate if the oversizing strategy compared with normal sizing was deleterious on the immediate and late post-procedural outcomes.

From January 2010 to August 2013, consecutive severe symptomatic aortic stenosis patients were referred for TAVI. They all underwent preoperative MultiSlice- angio CT scan (MSCT) and the procedures were achieved using Edwards Sapien^® or Corevalve devices^®. Early and late follow-up were completed. Retrospectively, according to pre-procedural MSCT and the valve size, patients were classified into three continuous groups: normal sizing, moderate and severe oversizing; depending on the ratio between the prosthesis area and the annulus area indexed and calculated on MSCT. Main endpoint was the all-cause and cardiovascular mortality and secondary endpoints corresponded to the VARC2 endpoints.

268 patients had a MSCT and underwent TAVI procedure, with mainly Corevalve ^®. While all-cause and cardiovascular mortality rates were similar in all groups, post-procedural new pace-maker implantation rate was significantly higher in the severe oversizing group (p=0.03), while we observed more in-hospital congestive heart-failure (p=0.02) and tamponade (p=0.02) in the normal sizing group. There was also a trend toward more moderate to severe AR in the normal sizing group (p=0.12). At 1 month there was significantly more MACCE in the normal sizing group (p=0.03). Oversizing based on this ratio is a safe and feasible strategy to reduce aortic leak with lower rates of immediate post-procedural complications and a similar long-term survival.