The role of selective multidetector computed tomography after transcatheter aortic valve implantation

Abstract Transcatheter aortic valve implantation is increasingly performed in younger and lower-risk patients, shifting attention toward long-term prosthetic valve durability. While transthoracic echocardiography remains the cornerstone of follow-up, it primarily reflects global hemodynamics and may not detect early structural or geometric abnormalities after implantation. Hypoattenuated leaflet thickening and reduced leaflet motion, collectively referred to as subclinical leaflet thrombosis, represent dynamic phenomena that may precede overt valve dysfunction. Growing evidence suggests that prosthesis geometry, including under-expansion, ellipticity, commissural misalignment, canting and implantation depth, may alter neo-sinus flow and promote thrombotic substrate formation. Multidetector computed tomography enables integrated assessment of leaflet morphology, perivalvular thrombus, and prosthetic geometry, providing insights into the mechanical determinants of thrombosis. In this State-of-the-Art review, we examine the role of multimodality imaging in identifying thrombogenic valve phenotypes and propose a pragmatic imaging framework integrating echocardiography with selective multidetector computed tomography to support individualized post-TAVI surveillance and management.