Study Limitations
Certain limitations of our analysis should be considered. First, studies
pooled in the report were all observational and susceptible to selection
and confounding bias. Second, due to the wide selection of studies from
all over the world with different expertise and devices, we expected
clinical heterogeneity. However, we aimed to perform an umbrella review
to identify all the predictors of PPMI post-TAVR that have remained
significant in multivariable-adjusted models. Third, despite appropriate
multivariable adjustment, residual confounding remains an issue from any
observational data. We hope that our analysis adds enough statistical
power to overcome the expected small study effects and confounders.
Finally, the studies used in our analysis included both older and newer
generation prostheses, so the risk factors identified could be
generalized but not applied individually to each device.