Abstract Body (Do not enter title and authors here): Background: Transcatheter aortic valve replacement (TAVR) is a well-established therapy for severe aortic stenosis. However, suboptimal prosthesis deployment—such as under-expansion or geometric distortion—has emerged as a potential contributor to adverse clinical outcomes. While postprocedural computed tomography (CT) enables objective evaluation of valve geometry, its prognostic value in routine clinical practice remains unclear. In particular, the long-term clinical impact of prosthesis deformation following balloon-expandable TAVR has not been well characterized. We sought to evaluate the association between CT-defined prosthesis deformation and long-term outcomes in a contemporary real-world cohort.

Methods: We analyzed 1,221 patients from the RESOLVE registry who underwent balloon-expandable TAVR at Cedars-Sinai Medical Center between 2015 and 2022 and survived ≥30 days post-procedure. Clinical and procedural data were obtained from the STS/TVT registry. All patients underwent contrast-enhanced CT 30 days post-TAVR, with prosthesis geometry assessed by an independent CT core laboratory. Deformation was defined as under-expansion <90% and/or eccentricity ≥10% across all three valve levels (inflow, mid, and outflow). The primary outcome was a composite of all-cause mortality, stroke, or heart failure hospitalization.

Results: Among the 1,221 patients, 313 (25.6%) exhibited prosthesis deformation. The overall cohort had a median follow-up of 5 years (IQR: 3–6). Baseline characteristics were generally comparable between groups, though deformation was more common in males (73.5% vs. 62.2%; p<0.001), those with hypertension (92.1% vs. 86.5%; p0.009), and recipients of a 29 mm valve (44.7% vs. 23.5%; p<0.001) (Table 1). The primary composite outcome was more frequent in the deformation group, with a significantly increased risk on Cox regression (HR 1.26; 95% CI 1.01–1.57; p0.03). Heart failure hospitalizations were also significantly higher. Although the absolute rate of myocardial infarction was lower, the adjusted risk was elevated. No significant differences were seen in all-cause mortality, stroke, new pacemaker implantation, or reintervention (Table 2).

Conclusion: In this high-volume TAVR cohort, prosthesis deformation was independently associated with worse long-term outcomes. These findings highlight the potential role of postprocedural CT imaging in identifying high-risk patients and informing strategies to optimize long-term outcomes following TAVR.