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Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document.

Publication ,  Journal Article
Kappetein, AP; Head, SJ; Généreux, P; Piazza, N; van Mieghem, NM; Blackstone, EH; Brott, TG; Cohen, DJ; Cutlip, DE; van Es, G-A; Hahn, RT ...
Published in: J Am Coll Cardiol
October 9, 2012

OBJECTIVES: The aim of the current Valve Academic Research Consortium (VARC)-2 initiative was to revisit the selection and definitions of transcatheter aortic valve implantation (TAVI) clinical endpoints to make them more suitable to the present and future needs of clinical trials. In addition, this document is intended to expand the understanding of patient risk stratification and case selection. BACKGROUND: A recent study confirmed that VARC definitions have already been incorporated into clinical and research practice and represent a new standard for consistency in reporting clinical outcomes of patients with symptomatic severe aortic stenosis (AS) undergoing TAVI. However, as the clinical experience with this technology has matured and expanded, certain definitions have become unsuitable or ambiguous. METHODS AND RESULTS: Two in-person meetings (held in September 2011 in Washington, DC, USA, and in February 2012 in Rotterdam, the Netherlands) involving VARC study group members, independent experts (including surgeons, interventional and non-interventional cardiologists, imaging specialists, neurologists, geriatric specialists, and clinical trialists), the US Food and Drug Administration (FDA), and industry representatives, provided much of the substantive discussion from which this VARC-2 consensus manuscript was derived. This document provides an overview of risk assessment and patient stratification that need to be considered for accurate patient inclusion in studies. Working groups were assigned to define the following clinical endpoints: mortality, stroke, myocardial infarction, bleeding complications, acute kidney injury, vascular complications, conduction disturbances and arrhythmias, and a miscellaneous category including relevant complications not previously categorized. Furthermore, comprehensive echocardiography recommendations are provided for the evaluation of prosthetic valve (dys)function. Definitions for the quality of life assessments are also reported. These endpoints formed the basis for several recommended composite endpoints. CONCLUSIONS: This VARC-2 document has provided further standardization of endpoint definitions for studies evaluating the use of TAVI, which will lead to improved comparability and interpretability of the study results, supplying an increasingly growing body of evidence with respect to TAVI and/or surgical aortic valve replacement. This initiative and document can furthermore be used as a model during current endeavors of applying definitions to other transcatheter valve therapies (for example, mitral valve repair).

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

October 9, 2012

Volume

60

Issue

15

Start / End Page

1438 / 1454

Location

United States

Related Subject Headings

  • Humans
  • Heart Valve Prosthesis Implantation
  • Consensus Development Conferences as Topic
  • Cardiovascular System & Hematology
  • Cardiac Catheterization
  • Biomedical Research
  • Aortic Valve Stenosis
  • Academies and Institutes
  • 3201 Cardiovascular medicine and haematology
  • 1117 Public Health and Health Services
 

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Kappetein, A. P., Head, S. J., Généreux, P., Piazza, N., van Mieghem, N. M., Blackstone, E. H., … Leon, M. B. (2012). Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. J Am Coll Cardiol, 60(15), 1438–1454. https://doi.org/10.1016/j.jacc.2012.09.001
Kappetein, A Pieter, Stuart J. Head, Philippe Généreux, Nicolo Piazza, Nicolas M. van Mieghem, Eugene H. Blackstone, Thomas G. Brott, et al. “Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document.J Am Coll Cardiol 60, no. 15 (October 9, 2012): 1438–54. https://doi.org/10.1016/j.jacc.2012.09.001.
Kappetein AP, Head SJ, Généreux P, Piazza N, van Mieghem NM, Blackstone EH, et al. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. J Am Coll Cardiol. 2012 Oct 9;60(15):1438–54.
Kappetein, A. Pieter, et al. “Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document.J Am Coll Cardiol, vol. 60, no. 15, Oct. 2012, pp. 1438–54. Pubmed, doi:10.1016/j.jacc.2012.09.001.
Kappetein AP, Head SJ, Généreux P, Piazza N, van Mieghem NM, Blackstone EH, Brott TG, Cohen DJ, Cutlip DE, van Es G-A, Hahn RT, Kirtane AJ, Krucoff MW, Kodali S, Mack MJ, Mehran R, Rodés-Cabau J, Vranckx P, Webb JG, Windecker S, Serruys PW, Leon MB. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. J Am Coll Cardiol. 2012 Oct 9;60(15):1438–1454.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

October 9, 2012

Volume

60

Issue

15

Start / End Page

1438 / 1454

Location

United States

Related Subject Headings

  • Humans
  • Heart Valve Prosthesis Implantation
  • Consensus Development Conferences as Topic
  • Cardiovascular System & Hematology
  • Cardiac Catheterization
  • Biomedical Research
  • Aortic Valve Stenosis
  • Academies and Institutes
  • 3201 Cardiovascular medicine and haematology
  • 1117 Public Health and Health Services