Impact of preoperative sarcopenia on the mortality risk in patients undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis

Background: The association of preoperative sarcopenia with risk of mortality among patients undergoing transcatheter aortic valve implantation (TAVI) remains unclear. This study aimed to clarify the impact of sarcopenia on the mortality risk in such patients. Methods: PubMed, Embase and Web of Science databases were searched up to June 2, 2026. Primary outcome was the all-cause mortality and secondary outcomes were cardiovascular mortality and non-cardiovascular mortality. Subgroup analyses based on the defined indicators of sarcopenia and study design were performed. Results: Thirteen studies with 6,865 patients were included and most studies were retrospective. Pooled results demonstrated that the presence of sarcopenia was significantly associated with increased risk of all-cause mortality [hazard ratio (HR) =1.55, 95% confidence interval (CI): 1.31-1.84, P<0.001]. Subgroup analyses based on the defined indicators (cross-sectional area: HR =1.55, P=0.04; skeletal muscle mass index: HR =1.41, P=0.002; psoas muscle area: HR =1.37, P=0.02; psoas muscle volume index: HR =1.77, P=0.003; psoas muscle index: HR =1.68, P<0.001) and study design (retrospective: HR =1.51, P<0.001; prospective: HR =2.69, P=0.02) manifested consistent results. Besides, presence of sarcopenia was also associated with increased risk of cardiovascular mortality (HR =1.14, 95% CI: 1.01-1.28, P=0.03), which was indicated by one available study. Conclusions: The presence of preoperative sarcopenia indicated higher risk of all-cause and cardiovascular mortality among patients undergoing TAVI.