Transcatheter aortic valve implantation in the elderly: An umbrella review

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 role of multidimensional assessment of elderly patients scheduled for TAVI, in order to maximize its appropriateness, effectiveness, and safety. Conclusion: It is crucial to consider frailty scores, as well as nutrition and functional status, in addition to established surgical risk scores, in elderly patients considered for TAVI to improve risk prediction, reinforcing the favorable impact of this therapy to improve cognitive function.