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Antonazzo et al. Vessel Plus 2020;4:3 Vessel Plus
DOI: 10.20517/2574-1209.2019.33

Systematic Review Open Access

Transcatheter aortic valve implantation in the

elderly: an umbrella review

Barbara Antonazzo , Giuseppe Biondi-Zoccai , Antonino G. M. Marullo , Giacomo Frati , Stefano
1,4
1
2,3
1
Ronzoni , Giovanni A. Chiariello , Francesco Versaci , Arturo Giordano 7
6
5
1
1 Division of Geriatrics, Israelite Hospital, Rome 00148, Italy.
2 Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina 04110, Italy.
3 Mediterranea Cardiocentro, Napoli 80122, Italy.
4 IRCCS NEUROMED, Pozzilli 86077, Italy.
5 Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome
00168, Italy.
6 UOC UTIC Emodinamica e Cardiologia, S. Maria Goretti Hospital, Latina 04100, Italy.
7 Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno 81030, Italy.
Correspondence to: Prof. Giuseppe Biondi-Zoccai, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza
University of Rome, Corso della Repubblica 79, Latina 04100, Italy. E-mail: giuseppe.biondizoccai@uniroma1.it

How to cite this article: Antonazzo B, Biondi-Zoccai G, Marullo AGM, Frati G, Ronzoni S, Chiariello GA, Versaci F, Giordano A.
Transcatheter aortic valve implantation in the elderly: an umbrella review. Vessel Plus 2020;4:3.
http://dx.doi.org/10.20517/2574-1209.2019.33

Received: 11 Dec 2019 First Decision: 30 Dec 2019 Revised: 11 Jan 2020 Accepted: 14 Jan 2020 Published: 12 Feb 2020

Science Editor: Mario F. L. Gaudino Copy Editor: Jing-Wen Zhang Production Editor: Tian Zhang

Abstract
Aim: The management of aortic stenosis has seen momentous changes thanks to the introduction of transcatheter aortic
valve implantation (TAVI, i.e., transcatheter aortic valve replacement). Indications to TAVI have expanded progressively
to intermediate- and low-risk patients, but trends in life expectancy have led to an increase of elderly but fit individuals
with aortic stenosis eligible for TAVI.

Methods: We reviewed the current evidence base on TAVI in the elderly by conducting an umbrella review (i.e., overview
of systematic reviews), based on a formal bibliographic search for systematic reviews on TAVI in elderly patients
(≥ 65 years). Key, study, patient, procedural, and outcome data were extracted, and validity formally appraised with the
Oxman-Guyatt index.

Results: From 71 citations, eight reviews were included (totaling 39 studies and 8579 patients): five systematic reviews,
and three meta-analyses. Topics of interest were cognitive function before and after TAVI, predictive role of muscle mass
and frailty on post-TAVI outcomes, comparative safety and effectiveness of TAVI, and role of rehabilitation to improve
patient outlook after TAVI. Thirty-three additional studies were retrieved by means of snowballing, emphasizing the

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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