{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T09:09:13Z","timestamp":1790154553362,"version":"4.0.1"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"15","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,8,5]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">The Valve Academic Research Consortium (VARC) has updated criteria for periprocedural bleeding after transcatheter aortic valve replacement. However, clinical validation of the VARC\u20103 bleeding definition is scarce. The aim of this study was to evaluate incidence, associated variables, and clinical impact of VARC\u20103 bleeding.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods<\/jats:title>\n            <jats:p xml:lang=\"en\">The study included 2227 patients with severe aortic stenosis undergoing transcatheter aortic valve replacement between 2018 and 2023 at the University Hospital Cologne. VARC\u20103 bleeding during the index hospitalization were analyzed. Incidence, variables associated with bleeding, and impact on 30\u2010day mortality were evaluated by comparison to the VARC\u20102 criteria. All data were prospectively collected.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              VARC\u20103 bleeding was 2.5 times more prevalent than VARC\u20102 (13.9% versus 34.4%), as VARC\u20103 includes nonattributable blood loss &gt;3\u2009g\/dL as a bleeding event. Chronic kidney disease, thoracotomy access, dual antiplatelet therapy (\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              &lt;0.001 for all), and female sex (\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              =0.023) were variables associated with VARC\u20103 bleedings. Type 3 bleeding (VARC\u20103) was associated with an increased 30\u2010day mortality (hazard ratio [HR], 2.89 [95% CI, 1.35\u20136.19],\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              =0.006). VARC\u20102 major and life\u2010threatening bleeding events were associated with increased 30\u2010day mortality as well (HR, 2.74 [95% CI, 1.26\u20135.95],\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              =0.011 and HR, 29.60 [95% CI, 17.42\u201350.30],\n              <jats:italic toggle=\"no\">P<\/jats:italic>\n              &lt;0.001).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">The VARC\u20103 criteria present a refined classification for bleeding with prognostic relevance. However, the VARC\u20102 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.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.124.039342","type":"journal-article","created":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T12:02:21Z","timestamp":1752753741000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Comparison of Valve Academic Research Consortium (VARC)\u20102 and VARC\u20103 Criteria for Bleeding Complications After Transcatheter Aortic Valve Replacement"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5779-7549","authenticated-orcid":false,"given":"Stephan","family":"Nienaber","sequence":"first","affiliation":[{"name":"Faculty of Medicine and University Hospital, University of Cologne","place":["Cologne, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janosch","family":"Himken","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and University Hospital, University of Cologne","place":["Cologne, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Max","family":"Meertens","sequence":"additional","affiliation":[{"name":"University Medical Center of the Johannes Gutenberg\u2010University Mainz","place":["Mainz, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2678-3501","authenticated-orcid":false,"given":"Victor","family":"Mauri","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and University Hospital, University of Cologne","place":["Cologne, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6768-7079","authenticated-orcid":false,"given":"Samuel","family":"Lee","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and University Hospital, University of Cologne","place":["Cologne, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3437-7450","authenticated-orcid":false,"given":"Jonathan","family":"Curio","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and University Hospital, University of Cologne","place":["Cologne, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6301-7422","authenticated-orcid":false,"given":"Elmar","family":"Kuhn","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and University Hospital, University of Cologne","place":["Cologne, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1336-6031","authenticated-orcid":false,"given":"Richard","family":"Nies","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and University Hospital, University of Cologne","place":["Cologne, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6941-7785","authenticated-orcid":false,"given":"Kaveh","family":"Eghbalzadeh","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and University Hospital, University of Cologne","place":["Cologne, Germany"]},{"name":"University Hospital Bonn","place":["Bonn, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Dohr","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and University Hospital, University of Cologne","place":["Cologne, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8259-1737","authenticated-orcid":false,"given":"Stephan","family":"Baldus","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and University Hospital, University of Cologne","place":["Cologne, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5810-2868","authenticated-orcid":false,"given":"Hendrik","family":"Wienemann","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and University Hospital, University of Cologne","place":["Cologne, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6990-8135","authenticated-orcid":false,"given":"Matti","family":"Adam","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and University Hospital, University of Cologne","place":["Cologne, 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