title: Prognostic value of the ratio between prosthesis area and indexed annulus area measured by MultiSlice-CT for transcatheter aortic valve implantation procedures.
abstract: BACKGROUND
  Postprocedural aortic regurgitations following transcatheter aortic valve implantation (TAVI) procedures remain an issue. Benefit of oversizing strategies to prevent them isn't well established. We compared different level of oversizing in our cohort of consecutive patients to address if severe oversizing compared to normal sizing had an impact on post-procedural outcomes.
  
  
  METHODS
  From January 2010 to August 2013, consecutive patients were referred for TAVI with preoperative Multislice-CT (MSCT) and the procedures were achieved using Edwards Sapien(®) or Corevalve devices(®). Retrospectively, according to pre-procedural MSCT and the valve size, patients were classified into three groups: normal, moderate and severe oversizing; depending on the ratio between the prosthesis area and the annulus area indexed and measured on MSCT. Main endpoint was mid-term mortality and secondary endpoints were the Valve Academic Research Consortium (VARC-2) endpoints.
  
  
  RESULTS
  Two hundred and sixty eight 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 pacemaker (PM) 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) in the normal sizing group. There was a trend toward more moderate to severe aortic regurgitation (AR) in the normal sizing group (P = 0.07).
  
  
  CONCLUSIONS
  Despite a higher rate of PM implantation, oversizing based on this ratio reduces aortic leak with lower rates of post-procedural complications and a similar mid-term survival.
authors: Heart Team, Lille University Hospital, Lille, France.
authors: Nicolas
authors: N
authors: Debry
authors: Heart Team, Lille University Hospital, Lille, France.
authors: Arnaud
authors: A
authors: Sudre
authors: Heart Team, Lille University Hospital, Lille, France.
authors: Ibrahim
authors: I
authors: Elquodeimat
authors: Heart Team, Lille University Hospital, Lille, France.
authors: Cédric
authors: C
authors: Delhaye
authors: Heart Team, Lille University Hospital, Lille, France.
authors: Guillaume
authors: G
authors: Schurtz
authors: Heart Team, Lille University Hospital, Lille, France.
authors: Antoine
authors: A
authors: Bical
authors: Heart Team, Lille University Hospital, Lille, France.
authors: Mohamad
authors: M
authors: Koussa
authors: Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital; Department of Surgery and Cancer, University of Palermo, Palermo, Italy.
authors: Khalil
authors: K
authors: Fattouch
authors: Heart Team, Lille University Hospital, Lille, France.
authors: Thomas
authors: T
authors: Modine
keywords: Aortic regurgitation; Aortic valve stenosis; Multislice-CT; Oversizing; Transcatheter aortic valve implantation