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

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VARC-3 WRITING COMMITTEE, Généreux, Philippe, Piazza, Nicolo, Alu, Maria C, Nazif, Tamim, Hahn, Rebecca T, Pibarot, Philippe, Bax, Jeroen J, Leipsic, Jonathon A, Blanke, Philipp, Blackstone, Eugene H, Finn, Matthew T, Kapadia, Samir, Linke, Axel, Mack, Michael J, Makkar, Raj, Mehran, Roxana, Popma, Jeffrey J, Reardon, Michael, Rodes-Cabau, Josep, Van Mieghem, Nicolas M, Webb, John G, Cohen, David J, Leon, Martin B·2021·European Heart Journal
DOI 10.1093/eurheartj/ehaa799
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Abstract

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.

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Metadata

Authors
VARC-3 WRITING COMMITTEE, Généreux, P., Piazza, N., Alu, M. C., Nazif, T., Hahn, R. T., Pibarot, P., Bax, J. J., Leipsic, J. A., Blanke, P., Blackstone, E. H., Finn, M. T., Kapadia, S., Linke, A., Mack, M. J., Makkar, R., Mehran, R., Popma, J. J., Reardon, M., Rodes-Cabau, J., Van Mieghem, N. M., Webb, J. G., Cohen, D. J., & Leon, M. B.
Venue
European Heart Journal
Publisher
Oxford University Press (OUP)
Published
2021-04-19
Volume
42
Issue
19
Pages
1825-1857
ISSN
  • 0195-668X (ISSN-L)
  • 1522-9645
DOI
10.1093/eurheartj/ehaa799
OpenAlex
W3156869543
Cited by
915
References
227
FWCI
44.97
Type
journal article
Language
en
Open access
bronze
Licence
academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)

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CoChat. (2026). Citation check: Valve Academic Research Consortium 3: updated endpoint definitions for aortic valve clinical research. https://app.cochat.ai/papers/10.1093/eurheartj/ehaa799
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VARC-3 WRITING COMMITTEE, Généreux, P., Piazza, N., Alu, M. C., Nazif, T., Hahn, R. T., Pibarot, P., Bax, J. J., Leipsic, J. A., Blanke, P., Blackstone, E. H., Finn, M. T., Kapadia, S., Linke, A., Mack, M. J., Makkar, R., Mehran, R., Popma, J. J., Reardon, M., . . . Leon, M. B. (2021). Valve Academic Research Consortium 3: updated endpoint definitions for aortic valve clinical research. European Heart Journal. https://doi.org/10.1093/eurheartj/ehaa799

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Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).

Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.