aortic valve area (1.33  0.41 cm2 vs. 1.52  0.5 cm2). In a multivariate analysis for elevated mean gradients within those with small surgical valves, CoreValve use (OR 0.56, CI 0.31 – 0.97, p ¼ 0.04), true internal diameter (OR 0.72, CI 0.59 – 0.87, p ¼ 0.001), THV size (OR 0.79, CI 0.65 – 0.97, p ¼ 0.02) and baseline regurgitation (OR 0.45, CI 0.21 – 0.93, p ¼ 0.03) were identified as protective factors. For survival, a Cox regression demonstrated that STS score (OR 1.04, CI 1.02-1.06, p < 0.001) and baseline regurgitation (OR 0.53, CI 0.29 – 0.98, p ¼0.04) were independently correlated with one year mortality in patients with small surgical valves. CONCLUSION ViV in small surgical valves offers exceptional chal- lenges. Stenosis as the mechanism of failure in these valves is an important aspect associated with worse hemodynamics and poor survival after the procedure. Careful patient evaluation is a key for procedural success when attempting ViV in small surgical valves. CATEGORIES STRUCTURAL: Valvular Disease: Aortic TCT-670 Optimal Transcatheter Heart Valve Sizing in Aortic Valve in Valve Implantation: Insights from the Valve in Valve International Data (VIVID) Registry Sami Alnasser, 1 Asim Cheema, 2 Eric Horlick, 3 Nicolas Van Mieghem, 4 Gudrun Feuchtner, 5 Matheus Simonato dos Santos, 6 Tanja Rudolph, 7 Stephen Brecker, 8 Pedro Lemos, 9 Nicolo Piazza, 10 Anibal Damonte, 11 Malek Kass, 12 Gábor Veress, 13 Julinda Mehilli, 14 Raffi Bekeredjian, 15 James McCabe, 16 Axel Linke, 17 Felix Woitek, 18 Lars Sondergaard, 19 Nikolaos Bonaros, 20 Ole De Backer, 21 Stephan Ensminger, 22 Hardy Baumbach, 23 Jochen Wöhrle, 24 Joachim Schofer, 25 Marc Pelletier, 26 John Webb, 27 Danny Dvir 28 1 University of Toronto, Toronto, Ontario, Canada; 2 University of Toronto, Toronto, Ontario, Canada; 3 University Health Network Toronto General Hospital, Toronto, Ontario, Canada; 4 Erasmus Medical Center, Rotterdam, Netherlands; 5 Innsbruck, Austria; 6 Federal University of Sao Paulo, Vancouver, Brazil; 7 Metro Health Hospital; 8 St. George’s Hospital, London, United Kingdom; 9 University of São Paulo Medical School, São Paulo, São Paulo, Brazil; 10 McGill University Health Center, Montreal, Quebec, Canada; 11 Instituto Cardiovascular de Rosario, Rosario, Argentina; 12 SBGH, Winnipeg, Manitoba, Canada; 13 Heart Center Balatonfüred, Munich, Germany; 14 Munic University Clinic Ludwig-Maximilians University; 15 Heidelberg University Hospital; 16 University of Washington, Seattle, Washington, United States; 17 University of Leipzig Heart Center, Leipzig, Germany; 18 University of Leipzig - Heart Center, Leipzig, Germany; 19 Rigshospitalet, Copenhagen, Denmark; 20 Innsbruck Medical University, Innsbruck, Austria; 21 Rigshospitalet, Copenhagen, Denmark; 22 Heart and Diabetes Center NRW, Bad Oeynhausen, Germany; 23 Robert Bosch Hospital, Stuttgart, Germany; 24 University Hospital Ulm, Ulm, Germany; 25 Hamburg University Cardiovascular Center and Department for percutaneous treatment of structural hea, Hamburg, Germany; 26 Mount Sinai Beth Israel, Boston, Massachusetts, United States; 27 St. Paul’s Hospital, Vancouver, British Columbia, Canada; 28 St. Paul’s Hospital, Vancouver, British Columbia, Canada BACKGROUND Optimal transcatheter heart valve (THV) sizing is crucial to optimize procedural outcomes. Larger THV oversizing is shown to decrease paravalvular leakage post transcatheter aortic valve replacement but its role in Valve in Valve implantation (ViV) is not well established. METHODS For each surgical type and label size, the two commonly used THV sizes, a given THV “standard” vs. a size larger “oversized” were compared among patients undergoing aortic ViV within VIVID Registry. The degree of THV perimeter oversizing was calculated as: (THV nominal size – surgical valve true ID)/true ID x 100. RESULTS A total of 595 patients (359 for standard size and 236 for oversized group) were included in the analysis. Baseline clinical, he- modynamic and surgical valve parameters were similar in these two groups. Both groups used similar THV devices in each matched com- parison. The oversized group received a larger THV (25.5 1.4 mm vs. 23.3  1.0 mm, p<0.001) with a greater degree of THV oversizing (31%  10.6 vs. 20%  9.5, p¼<0.001) compared to the standard cohort. Post- implantation, the oversized group achieved a larger EOA (1.540.4cm2 vs. 1.37 0.5cm2, p<0.001) and lower MG (15.18.1mmHg vs. 17.48.5mmHg, p¼0.002) in comparison to the standard cohort. The oversized group however, had a higher rate of moderate to severe AI (6.9% vs. 2.7%, p¼0.001) and second THV requirement (5.5%vs. 2.2%, p¼0.04). THV mal-positioning, coronary obstruction and post- operative pacemaker requirement were not significantly different. THV oversizing was an independent predictor of the observed hemodynamic differences: (b 0.01, p ¼ 0.001), (b 0.23, p ¼<0.001), Odds ratio 1.06 (1.005 - 1.113), p ¼ 0.031 for EOA, MG and AI respectively. CONCLUSION The strategy of highly oversized THV selection for ViV implantation was associated with favorable post-implant EOA and gradient but a higher risk of aortic insufficiency and THV re-inter- vention. Further exploration within various THV and surgical valve types at different degree of THV oversizing is planned. CATEGORIES STRUCTURAL: Valvular Disease: Aortic TCT-671 The Role of Pre-existing Aortic Regurgitation on The Clinical Impact of Aortic Regurgitation after Transcatheter Aortic Valve Implantation Hiroki Tateishi, 1 Mohammad Abdelghani, 2 Rafael Cavalcante, 3 Yosuke Miyazaki, 4 Carlos Campos, 5 Carlos Collet, 6 Tristan Slots, 7 Rogerio Sarmento-Leite, 8 Jose Mangione, 9 Alexandre Abizaid, 10 Osama Soliman, 11 Ernest Spitzer, 12 Yoshinobu Onuma, 13 Patrick Serruys, 14 Pedro Lemos, 15 Fabio Brito 16 1 Erasmus MC, Rotterdam, Netherlands; 2 Academic Medical Center- University of Amsterdam, Amsterdam, Netherlands; 3 Thoraxcenter, Erasmus MC, Rotterdam, Netherlands; 4 Erasmus MC, Rotterdam, Netherlands; 5 incor, São Paulo, São Paulo, Brazil; 6 Clinica El Avila, Caracas, Venezuela; 7 Pie Medical Imaging B.V., Maastricht, Netherlands; 8 Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; 9 Hospital Beneficência Portuguesa, São Paulo, São Paulo, Brazil; 10 Instituto Dante Pazzanese de Cardiologia, São Paulo, São Paulo, Brazil; 11 Erasmus MC and Cardialysis, Rotterdam, Netherlands; 12 Cardialysis, Rotterdam, Netherlands; 13 Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands; 14 Imperial College, London/Thoraxcenter of Erasmus University, Rotterdam, Netherlands; 15 University of São Paulo Medical School, São Paulo, São Paulo, Brazil; 16 University of Texas Health Science Center at San Antonio, Sao Paulo, São Paulo, Brazil BACKGROUND To evaluate the long-term clinical impact of AR after TAVI using a novel quantitative angiographic method taking into account the role of pre-existing AR. The clinical impact of aortic regurgitation (AR) ensuing after transcatheter aortic valve implanta- tion (TAVI) could be influenced by preconditioning of the ventricle by pre-existing AR. METHODS AR after TAVI was quantified in 338 patients (age, 82 [78-86] years; 55% males) and the influence on long-term all-cause mortality was evaluated. In 228 aortograms, AR was quantitated using a dedicated contrast-densitometry software focused in the the left ventricular outflow tract (LVOT-AR). RESULTS Patients with LVOT-AR >0.17 had a significantly increased all-cause mortality at 3-year, compared with patients who had LVOT-AR 0.17 [45.5% vs. 37.7%, adjusted hazard ratio (HR): 1.73, 95% confidence interval (CI) (1.05-2.86), p¼0.032]. Taking the influence of pre-existing AR into account (n¼ 201), patients with post-procedural LVOT-AR >0.17 and no significant (mild) pre-existing AR had a signif- icantly increased mortality at 2-year, compared to patients with LVOT- AR >0.17 and significant (more than mild) pre-existing AR [HR 2.55, 95% CI (1.16-5.58), p¼0.029]. In those with a significant pre-existing AR (n¼70), post-TAVI LVOT-AR >0.17 was not associated with an increased risk of long-term mortality [HR: 0.77, 95% CI (0.31-1.91), p¼0.578]. CONCLUSION AR after TAVI could be quantitated utilizing LVOT-AR. The cut-point of >0.17 indicates a significant AR pertaining to increased long-term all-cause mortality especially in those with no significant pre-existing AR. CATEGORIES STRUCTURAL: Valvular Disease: Aortic TCT-672 Outcomes in the Commercial Use of Self-expanding Prostheses in Transcatheter Aortic Valve Replacement: A Comparison of the Medtronic CoreValve and Evolut R platforms in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy RegistryTM Paul Sorajja, 1 Susheel Kodali, 2 Michael Reardon, 3 Wilson Szeto, 4 Stanley Chetcuti, 5 James Hermiller, Jr., 6 David Adams, 7 Jeffrey Popma 8 1 Minneapolis Heart Institute, Minneapolis, Minnesota, United States; 2 NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York, United States; 3 Houston Methodist DeBakey JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 68, NO. 18, SUPPL B, 2016 B271