Incidence, Predictors, and Prognostic Impact of Bleeding Events After TAVR According to VARC-3 Criteria

Avvedimento, M; Real, C; Nuche, J; Farjat-Pasos, J; Galhardo, A; Trinh, KH; Robichaud, M; Delarochellière, R; Paradis, JM; Poulin, A; Dumont, E; Kalavrouziotis, D; Mohammadi, S; Côté, M; Rodés-Cabau, J

doi:10.1016/j.jcin.2023.07.005

Valvular & structural heart disease

Incidence, Predictors, and Prognostic Impact of Bleeding Events After Transcatheter Aortic Valve Replacement (TAVR) According to VARC-3 Criteria

JACC Cardiovasc IntervPublished 6 Sep 2023Prospective cohort study

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Authors' conclusion

Bleeding events after TAVR were associated with poorer short- and long-term survival. The magnitude of this correlation was proportional to bleeding severity defined according to VARC-3 criteria.

Study context

Population: Patients with severe symptomatic AS undergoing TAVR
Participants: 2,384 consecutive patients

Exposure: Bleeding events vs no bleeding after TAVR
Type 1n = 169
Type 2n = 399
Type 3n = 149
Type 4n = 44
Outcome: Incidence, predictors and clinical impact of bleeding events (VARC-3)
Follow-up: 24 [IQR: 12-43] months

Methodological detailsconsecutive patients

Consecutive patients

Main finding

As reported in the abstract

Bleeding events (VARC-3) by type

Any bleeding event: 761 patients (31.9%)
Type 1 bleeding: 169 (22.2%)
Type 2 bleeding: 399 (52.4%)
Type 3 bleeding: 149 (19.6%)
Type 4 bleeding: 44 (5.8%)

Observational data: associations, not effects.

Further findings

Mortality by bleeding type · 30-day and 1-year

	← Lower risk ←→ Higher risk →	HR (95% CI)	P value
Type 230-day	0.050.21520	2.94 (1.43–6.03)	P = 0.003
Type 330-day	0.050.21520	4.91 (2.19–11.03)	P < 0.001
Type 21-year	0.050.21520	1.86 (1.28–2.69)	P = 0.001
Type 31-year	0.050.21520	2.28 (1.41–3.66)	P = 0.001
	0.050.21520Hazard ratio (log scale)

Predictors of early bleeding

Female sex, thoracotomy access, larger (14-F) sheath, DAPT increased risk: P < 0.02 for all
Radial artery secondary access reduced risk: P < 0.001

Early bleeding incidence, VARC-2 vs VARC-3

Lower global incidence with VARC-2 (19% vs 27%): P < 0.001

Similar prognostic pattern with VARC-2

Original publication

Incidence, Predictors, and Prognostic Impact of Bleeding Events After TAVR According to VARC-3 Criteria. JACC Cardiovasc Interv. Published 6 September 2023. doi:10.1016/j.jcin.2023.07.005

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