Validation of the VARC-HBR consensus for defining high bleeding risk in TAVI

Transcatheter aortic valve implantation (TAVI) is increasingly performed across the entire surgical risk spectrum.1 Bleeding events remain one of the most frequent and clinically relevant complications, consistently associated with prolonged hospitalisation, impaired quality of life, and reduced survival.1 High bleeding risk (HBR) is common among TAVI patients, largely driven by advanced age, frailty, anaemia, renal dysfunction, and the need for antithrombotic therapy.2 Until recently, standardised definitions of bleeding risk tailored to the TAVI population were lacking.2

In 2024, the Valve Academic Research Consortium (VARC) introduced the VARC-HBR criteria to standardise bleeding risk stratification in TAVI, analogous to the Academic Research Consortium (ARC)-HBR in percutaneous coronary intervention.2 Based on expert consensus, 21 clinical, anatomical, and procedural factors were defined as major or minor criteria. Patients are stratified into four categories: low risk (no criteria), moderate risk (one minor criterion), high risk (one major or two minor criteria), and very high risk (two major or three minor criteria).2 Expected 1-year Bleeding Academic Research Consortium (BARC) Type 3 or 5 bleeding rates are <4% in moderate-risk, 4-8% in...