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Table 1. Included systematic reviews on TAVI in the elderly
Ref. PubMed ID Focus Studies Patients Highlights
Anand et al. [11] 28927173 Frailty 10 4592 Frailty is a significant predictor of adverse events after TAVI
Fink et al. [12] 26192563 Cognitive function 1 64 Cognitive function may be impaired after TAVI
Furukawa et al. [13] 25916404 Frailty 6 1023 Frailty is a significant predictor of adverse events after TAVI
Lai et al. [14] 25785192 Cognitive function 6 349 Cognitive function remains stable or improves after TAVI
Mohammadi et al. [15] 26728319 Effectiveness of TAVI NA NA TAVI impacts favorably on morbidity and mortality in elderly
patients with AS
Ribeiro et al. [16] 28071146 Rehabilitation 5 292 Cardiac rehabilitation improves functional capacity and QoL
after TAVI
Sepehri et al .[17] 25199821 Frailty 3 378 Frailty is a significant predictor of adverse events after TAVI
Soud et al. [18] 30915667 Muscle mass 8 1881 Skeletal muscle area appraised with CT is a significant
predictor of adverse events after TAVI
CT: computed tomography; NA: not applicable; QoL: quality of life; TAVI: transcatheter aortic valve implantation; AS: aortic stenosis

Figure 1. Review profile, detaling study search and selection

RESULTS
From an initial set of 1619 citations, a subset of 21 were retrieved as full-texts, finally yielding eight
reviews, totaling 39 primary studies and 8579 patients [Table 1 and Figure 1] [11-18] . Five were systematic
reviews only, and the remaining three also provided meta-analysis results [11,16,18] . The topics of interest were
cognitive function before and after TAVI [12,14] , predictive role of muscle mass and frailty on post-TAVI
[15]
outcomes [11,13,17,18] , comparative safety and effectiveness of TAVI , and role of rehabilitation to improve
[16]
patient outlook after TAVI . Review quality ranged from high validity and low risk of bias for five
reviews [11,12,16-18] , to low validity and high risk of bias in three reviews [13-15] [Table 2], with lack of adequate
reporting being the most common limitation.

[11]
In particular, Anand et al. performed a systematic review and meta-analysis appraising the prognostic
impact of frailty in patients undergoing TAVI, including a total of 10 studies and 4592 patients.
They concluded that frailty proved to be a significant predictor of adverse events after TAVI. Similar
[13]
findings were reported by prior reviews such as the systematic review conducted by Furukawa et al. ,
encompassing six primary studies and 1023 patients, and the one authored by Sepehri and colleagues,
[18]
[17]
totaling three studies and 378 subjects . A relatively similar focus was chosen by Soud et al. , who
pooled eight studies including 1881 to appraise the predictive usefulness of appraising skeletal muscle
mass by means of computed tomography (CT). CT-derived muscle area showed a significant prognostic