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Updated: Sep 11, 2025

Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
06:02

Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation

Published on: August 8, 2025

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Prevalence and prognostic implications of the Valve Academic Research Consortium-High Bleeding Risk criteria in

Davide Cao1,2, Marco Sandri3, Philippe Garot2,4

  • 1Department of Biomedical Sciences, Humanitas University, Milan, Italy.

Heart (British Cardiac Society)
|August 13, 2025
PubMed

Insights

Nearly 60% of patients undergoing transcatheter aortic valve implantation (TAVI) face high bleeding risk. The Valve Academic Research Consortium (VARC) criteria effectively predict bleeding complications and adverse events in TAVI patients.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • The Valve Academic Research Consortium (VARC) established criteria for high bleeding risk (HBR) in transcatheter aortic valve implantation (TAVI) patients.
  • Evaluating the prevalence and predictive value of these VARC-HBR criteria for in-hospital bleeding is crucial.

Purpose of the Study:

  • To assess the distribution of VARC-HBR categories in TAVI patients.
  • To determine the association between VARC-HBR criteria and in-hospital bleeding events.
  • To evaluate the predictive capability of VARC-HBR for adverse cardiovascular events and mortality.

Main Methods:

  • Analysis of 8464 patients undergoing TAVI across 18 European sites (2007-2022) from the Transfusion Requirements in Transcatheter Aortic Valve Implantation registry.
  • Stratification of patients into low, moderate, high, or very high bleeding risk groups using VARC-HBR criteria.
  • Primary outcome: in-hospital major or life-threatening bleeding (VARC-2 definition).

Main Results:

  • A significant proportion of patients were classified as high (39.1%) or very high (23.2%) bleeding risk.
  • In-hospital bleeding rates increased progressively with higher VARC-HBR categories (11.0% low risk to 22.2% very high risk; p<0.001).
  • Higher bleeding risk correlated with increased major adverse cardiovascular events and mortality, particularly within 3 months post-event.

Conclusions:

  • The VARC-HBR criteria identify a substantial number of TAVI patients at elevated risk for bleeding and adverse outcomes.
  • These criteria are valuable for risk stratification and may inform clinical management strategies in TAVI.
  • Progressive increase in adverse events across bleeding risk categories underscores the importance of bleeding risk assessment in TAVI.
Abstract

Keywords:
Aortic stenosisTranscatheter Aortic Valve Replacement

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