RHEIA: TAVI outperformed surgery in women with aortic stenosis

Transcatheter aortic valve replacement (TAVI) outperformed surgical valve replacement in terms of a composite outcome of death, stroke, or rehospitalisation in women with severe aortic stenosis. The less invasive TAVI treatment was also more beneficial concerning the use of healthcare resources, according to the RHEIA trial.

“Evidence suggests that TAVI may be preferred over surgery in patients with severe aortic stenosis due to a lower mortality rate with the first approach,” stated Prof. Hélène Eltchaninoff (University Hospital of Rouen, France). “However, women have been under-represented in studies comparing TAVI and surgery in low-risk patients.”

The RHEIA trial (NCT04160130) included women with severe aortic stenosis to compare TAVI with surgery and confirm the benefit of TAVI over surgery in women. The 443 participants were randomised 1:1 to TAVI or surgery and were evaluated for a primary composite endpoint of all-cause mortality, stroke, and rehospitalisation after 1 year of follow-up.

The primary endpoint event rate was significantly higher in the surgery arm than in the TAVI arm (15.6% vs 8.9%; HR 0.55; 95% CI 0.34–0.88; P_log-rank=0.03) [1]. “The effect was driven by a reduction in rehospitalisations in the TAVI arm,” explained Prof. Eltchaninoff (4.8% vs 11.4%; P=0.02). “We also saw that the incidence of new-onset atrial fibrillation was 7 times higher in the surgery arm than in the TAVI arm” (28.8% vs 3.3%; P<0.001). On the other hand, new permanent pacemakers were more common in the TAVI arm (8.8% vs 2.9%; P=0.01). Finally, participants in the TAVI arm had a shorter length of index hospital stay than participants in the surgery arm (median 4 vs 9 days).

“In women with severe aortic stenosis, TAVI was superior to surgery for the primary composite endpoint of death, stroke, or rehospitalisation,” concluded Prof. Eltchaninoff.

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   1. Eltchaninoff H, et al. RHEIA: randomised research in women all comers with aortic stenosis: transcatheter versus surgical aortic valve replacement in women. HOTLINE 5, ESC Congress 2024, 30 Aug–02 Sept, London, UK.

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Posted on 7 November 20247 November 2024