Open Access

Emre Polat, Lisa Müller, Lena Schemet, Sarah Friedrich-Welz, Mohamed Amer, Evaldas Girdauskas, Tamer Owais

• Background Elliptical annular anatomy has been considered a risk factor for adverse outcomes after TAVI, particularly paravalvular leakage (PVL). Prosthesis oversizing is thought to improve sealing, but the interaction between annular shape and sizing strategy remains unclear. Aim To evaluate the combined impact of annular shape and sizing strategy on procedural success and short-term outcomes. Methods In this retrospective single-center study, 509 patients undergoing TAVI between January 2021 and December 2024 were analyzed. Ellipticity index (EI) was defined as the ratio of maximum to minimum annular diameter on preprocedural CT. The sizing index (SI) was calculated as prosthesis diameter relative to mean annular diameter. Primary and secondary endpoints were device success and PVL ≥ mild, PPI, new-onset LBBB, and early safety. Results Mean EI and SI were 1.27 ± 0.10; 15.3% ± 12.4%. Device success was achieved in 89% and was not significantly associated with EI (aOR 0.197, 95%Background Elliptical annular anatomy has been considered a risk factor for adverse outcomes after TAVI, particularly paravalvular leakage (PVL). Prosthesis oversizing is thought to improve sealing, but the interaction between annular shape and sizing strategy remains unclear. Aim To evaluate the combined impact of annular shape and sizing strategy on procedural success and short-term outcomes. Methods In this retrospective single-center study, 509 patients undergoing TAVI between January 2021 and December 2024 were analyzed. Ellipticity index (EI) was defined as the ratio of maximum to minimum annular diameter on preprocedural CT. The sizing index (SI) was calculated as prosthesis diameter relative to mean annular diameter. Primary and secondary endpoints were device success and PVL ≥ mild, PPI, new-onset LBBB, and early safety. Results Mean EI and SI were 1.27 ± 0.10; 15.3% ± 12.4%. Device success was achieved in 89% and was not significantly associated with EI (aOR 0.197, 95% CI 0.013–3.309, p = 0.25). Increasing SI was associated with higher device success, although this association did not reach statistical significance (aOR 1.017, p = 0.088). Success rates peaked with moderate oversizing (6%–15%; 93%). PVL ≥ mild occurred in 30% with undersizing and 14% with optimal oversizing but showed no association with EI or SI. Heatmaps showed lower device success when high EI (> 1.32) coincided with suboptimal SI (≤ 5% or ≥ 25%). Conclusion Annular ellipticity alone did not predict adverse outcomes. While exploratory analysis suggested reduced device success in patients with both high ellipticity and suboptimal sizing, no significant interaction was identified. Moderate oversizing was associated with the most favorable results.…