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.