Valve Academic Research Consortium 3: Updated endpoint definitions for aortic valve clinical research

Philippe Généreux, Nicolo Piazza, Maria C. Alu, Tamim Nazif, Rebecca T. Hahn, Philippe Pibarot, Jeroen J. Bax, Jonathon A. Leipsic, Philipp Blanke, Eugene H. Blackstone, Matthew T. Finn, Samir Kapadia, Axel Linke, Michael J. Mack, Raj Makkar, Roxana Mehran, Jeffrey J. Popma, Michael Reardon, Josep Rodes-Cabau, Nicolas M. Van MieghemJohn G. Webb, David J. Cohen, Martin B. Leon*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

310 Citations (Scopus)
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Aims: The Valve Academic Research Consortium (VARC), founded in 2010, was intended to (i) identify appropriate clinical endpoints and (ii) standardize definitions of these endpoints for transcatheter and surgical aortic valve clinical trials. Rapid evolution of the field, including the emergence of new complications, expanding clinical indications, and novel therapy strategies have mandated further refinement and expansion of these definitions to ensure clinical relevance. This document provides an update of the most appropriate clinical endpoint definitions to be used in the conduct of transcatheter and surgical aortic valve clinical research.

Methods and results: Several years after the publication of the VARC-2 manuscript, an in-person meeting was held involving over 50 independent clinical experts representing several professional societies, academic research organizations, the US Food and Drug Administration (FDA), and industry representatives to

(i) evaluate utilization of VARC endpoint definitions in clinical research,

(ii) discuss the scope of this focused update, and

(iii) review and revise specific clinical endpoint definitions.

A writing committee of independent experts was convened and subsequently met to further address outstanding issues. There were ongoing discussions with FDA and many experts to develop a new classification schema for bioprosthetic valve dysfunction and failure. Overall, this multi-disciplinary process has resulted in important recommendations for data reporting, clinical research methods, and updated endpoint definitions. New definitions or modifications of existing definitions are being proposed for repeat hospitalizations, access site-related complications, bleeding events, conduction disturbances, cardiac structural complications, and bioprosthetic valve dysfunction and failure (including valve leaflet thickening and thrombosis). A more granular 5-class grading scheme for paravalvular regurgitation (PVR) is being proposed to help refine the assessment of PVR. Finally, more specific recommendations on quality-of-life assessments have been included, which have been targeted to specific clinical study designs.

Conclusions: Acknowledging the dynamic and evolving nature of less-invasive aortic valve therapies, further refinements of clinical research processes are required. The adoption of these updated and newly proposed VARC-3 endpoints and definitions will ensure homogenous event reporting, accurate adjudication, and appropriate comparisons of clinical research studies involving devices and new therapeutic strategies.

Original languageEnglish
Pages (from-to)1825-1857
Number of pages33
JournalEuropean Heart Journal
Issue number19
Publication statusPublished - 14 May 2021

Bibliographical note

Publisher Copyright:
© 2021 Published on behalf of the European Society of Cardiology. All rights reserved.


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