Key result
VARC-3 refines bleeding classification but VARC-2 better predicts mortality in the transfemoral cohort.
Why the study?
Clinical validation of the updated Valve Academic Research Consortium (VARC)-3 bleeding definition after transcatheter aortic valve replacement is scarce.
How do the VARC-3 bleeding criteria compare to VARC-2 criteria regarding incidence, associated variables, and impact on 30-day mortality in patients undergoing transcatheter aortic valve replacement?
Cohort (n=2,227)
No
How do the VARC-3 bleeding criteria compare to VARC-2 criteria regarding incidence, associated variables, and impact on 30-day mortality in patients undergoing transcatheter aortic valve replacement?
VARC-3 criteria provide a refined classification for bleeding with prognostic relevance, though VARC-2 criteria demonstrate clear correlation with mortality risk and potentially greater predictive accuracy in transfemoral TAVR.
Answers are grounded in this paper and cite their sources.
Supports refined bleeding classification post-TAVR; leaves open whether VARC-3 improves mortality prediction over VARC-2.
BACKGROUND: The Valve Academic Research Consortium (VARC) has updated criteria for periprocedural bleeding after transcatheter aortic valve replacement. However, clinical validation of the VARC-3 bleeding definition is scarce. The aim of this study was to evaluate incidence, associated variables, and clinical impact of VARC-3 bleeding. METHODS: The study included 2227 patients with severe aortic stenosis undergoing transcatheter aortic valve replacement between 2018 and 2023 at the University Hospital Cologne. VARC-3 bleeding during the index hospitalization were analyzed. Incidence, variables associated with bleeding, and impact on 30-day mortality were evaluated by comparison to the VARC-2 criteria. All data were prospectively collected. CONCLUSIONS: The VARC-3 criteria present a refined classification for bleeding with prognostic relevance. However, the VARC-2 criteria demonstrate precision and clear correlation with increasing mortality risk proportional to the severity of bleeding too, showing even greater predictive accuracy in the transfemoral cohort. These findings require further validation with similar or even larger patient cohorts.
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Nienaber et al. (2025) conducted a cohort in Severe aortic stenosis (n=2,227). VARC-3 bleeding criteria vs. VARC-2 bleeding criteria was evaluated on Incidence of bleeding and impact on 30-day mortality (p=<0.001). VARC-3 criteria provided a refined classification for bleeding with prognostic relevance, although VARC-2 criteria demonstrated greater predictive accuracy for mortality in the transfemoral cohort.
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