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Page 4 of 8 Antonazzo et al. Vessel Plus 2020;4:3 I http://dx.doi.org/10.20517/2574-1209.2019.33 Table 2. Validity appraisal of included systematic reviews on TAVI in the elderly

Ref.

Lai et al. [14]
Fink et al. [12]
Soud et al. [18]
Anand et al. [11]
Ribeiro et al. [16]
Sepehri et al. [17]
Furukawa et al. [13]
DISCUSSION
Mohammadi et al. [15]
No
No
Yes
Yes
Yes
Yes
Yes
Yes
Search
methods stated
Yes
Yes
Yes
Yes
Yes
Yes
NA
Yes
comprehensive
NA: not applicable; TAVI: transcatheter aortic valve implantation
No
No
No
Yes
Yes
Yes
Yes
Yes
reported
NA
NA
Yes
Yes
Yes
Yes
Yes
avoided
Unclear
No
No
No
Yes
Yes
Yes
Yes
Yes
reported
Yes
Yes
NA
Yes
NA
Yes
NA
Yes
appropriate
Search for evidence Inclusion criteria Selection bias Validity criteria Validity criteria
NA
NA
NA
Yes
Yes
NA
Yes
NA
Combination
methods appropriate
following TAVI, concluding that this protected discharge approach may improve functional capacity and quality of life.
Yes
NA
NA
NA
Yes
NA
Yes
NA
Combination
methods coherent
NA
NA
NA
NA
Yes
NA
Yes
Yes
Conclusions
every elderly patient with aortic stenosis considered for TAVI, in order to maximize appropriateness, maximize effectiveness, and minimize risk.
supported by results
rating
Overall
Low validity
Low validity
Low validity
High validity
High validity
High validity
High validity
High validity
studies, and three were diagnostic studies. The focus of reports varied, ranging from frailty appraisal tools to the electrical risk score, N-terminal pro-
surgical risk scores to improve the accuracy of risk prediction and ensuing decision-making, and promising data in favor of TAVI as a means to improve
cognitive function; and (3) Other studies, elicited from a scoping appraisal of the scholarly literature on TAVI in elderly patients, highlighted the importance
elderly patients with severe aortic stenosis awaiting TAVI, whereas this procedure is not associated with significant worsening in cognitive function (which
total, 33 reports were shortlisted, including as many as 30,657 subjects. Specifically, three were reviews, one was a qualitative study, 26 were observational
patients undergoing TAVI) and Lai et al. [14] (who overviewed six studies and 349 subjects). Notably, they found that cognitive decline is common among
this procedure, whereas Ribeiro et al. [16] reported the results of a meta-analysis spanning five studies and 292 patients on the use of cardiac rehabilitation
and cognitive function were the most commonly covered topics, with reports highlighting the importance of considering frailty scores on top of standard
role in patients undergoing TAVI. Cognitive function before and after TAVI was the topic of interest of Fink et al. [12] (who included only one study and 64
can actually improve after TAVI). Finally, Mohammadi et al. [15] reviewed several studies on TAVI in elderly patients to gauge the effectiveness and safety of
The present umbrella review, aiming at summarizing the evidence base for TAVI in elderly patients, has the following implications: (1) While TAVI has been
brain natriuretic peptide levels, oxygen consumption formulas, diagnosis of bicuspidy, nutritional status, grip strength, cognitive function, balloon aortic
valvuloplasty, postoperative delirium, and prehabilitation/rehabilitation. Overall, these reports highlight the importance of multidimensionally considering
offered mostly to patients at high surgical risk with advanced age, the evidence thus far accrued on TAVI in elderly subjects is relatively limited; (2) Frailty
Given the limited scope of the systematic reviews retrieved with a focused umbrella review approach, we also explored by means of snowballing other
bibliographic sources, highlighting several important primary studies on the indications, subtleties, and outlook of TAVI in elderly patients [Table 3]. In