Objective To explore the predictive value of the advanced lung cancer inflammation index (ALI) for major adverse cardiovascular events (MACE) in patients undergoing transcatheter aortic valve replacement (TAVR). Methods A retrospective analysis was conducted on patients with severe aortic stenosis who underwent TAVR at the Department of Cardiology, West China Hospital of Sichuan University between April 2012 and September 2023. The primary endpoint was MACE. Participants were stratified into different subgroups based on the cutoff value of ALI. Kaplan-Meier survival analysis was used to evaluate the differences in prognosis, and the Cox proportional hazards regression model and restricted cubic spline analysis were used to analyze the relationship between ALI and the risk of MACE. Results A total of 1752 patients were included, with a median follow-up of 2.46 years. In the fully adjusted Cox regression model, each unit increase in ALI was associated with a 2% reduction in the risk of MACE [hazard ratio (HR)=0.98, 95% confidence interval (CI) (0.97, 0.99), P<0.001]. Additionally, compared with the ALI<39.58 group, the ALI≥39.58 group had a 59% lower risk of MACE [HR=0.41, 95%CI (0.30, 0.55), P<0.001]. The restricted cubic spline model indicated a linear relationship between ALI and the risk of MACE (P for overall<0.001, P for non-linear=0.652). Conclusion ALI is significantly associated with MACE in patients after TAVR; ALI≤39.58 is an independent risk factor and can be used as a prognostic indicator for preoperative risk stratification and treatment decision-making.