Sarcopenia as a predictor of outcome after transcatheter aortic valve implantation: protocol for systematic review and meta-analysis

INTRODUCTION: Sarcopenia represents a central biological substratum of frailty, which increases the incidence of adverse events and mortality after surgery for oesophageal cancer, gastrectomy and pancreatic surgery. Recently, sarcopenia has been suggested as a predictor of outcomes in patients undergoing transcatheter aortic valve implantation (TAVI). However, since relevant data were variable, we aimed to perform a systematic review and meta-analysis of the current literature to evaluate sarcopenia as a predictor of post-TAVI outcomes. METHODS AND ANALYSIS: Two investigators will conduct independent searches in PubMed, EMBASE, Web of Science, MEDLINE and the Cochrane Library, from database inception to October 2022. The search will not be limited by language or region. Eligible studies will include reports investigating post-TAVI outcomes in patients with sarcopenia, who are aged >18 years and diagnosed using a CT scan. The primary outcome is short-term mortality (30-day mortality), while the secondary outcomes include long-term mortality (>30 days), length of intensive care unit (ICU) stay, need for ICU admission (the number of patients in the sarcopenia or non-sarcopenia group requiring ICU admission), length of hospital stay and overall complications. Included studies will be assessed for risk of bias according to the Quality in Prognosis Studies critical assessment tool and certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation. The analysis will be done with Review Manager (V.5.4) software. If testing reveals little or no statistical heterogeneity, a fixed-effect model will be used for data synthesis; otherwise, a random-effect model may be employed. On encountering substantial heterogeneity, subgroup analysis and leave-one-out jackknife sensitivity analysis will be used to verify the robustness of the results. The obtained results will be presented as forest plots while Cochran’s Q test and I(2) test will be used to calculate the heterogeneity (>50% indicating strong heterogeneity). ETHICS AND DISSEMINATION: No ethical approval is needed for this study since we will be using data from previously published studies. The results will be disseminated in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42022349525.