Commentary: Robotic surgical aortic valve replacement: An evolving option

Central MessageRobotic aortic valve replacement (rAVR) through the lateral approach is a promising new minimally invasive technique in our surgical armamentarium for replacement.See Article page 1753. Robotic replacement. See This report by Badhwar and colleagues1Badhwar V. Wei L. Cook C.C. Hayanga J.A. Daggubati R. Sengupta P.P. et al.Robotic replacement.J Thorac Cardiovasc Surg. 2021; 161: 1753-1759Scopus (11) Google Scholar describes successful operative early results of robotic 20 patients using conventional prostheses via unique approach. We congratulate authors this important contribution that advances application platform (AVR). To date, reports describing rAVR are limited to isolated, single-digit case series primarily an anterior-medial sutureless valves.2Folliguet T.A. Vanhuyse F. Konstantinos Z. Laborde Early experience with replacement.Eur J Cardiothorac 2005; 28: 172-173Crossref PubMed Scopus (35) Scholar, 3Nagaoka E. Gelinas J. Vola M. Kiaii B. clinical experiences assisted stenosis valve.Innovations. 2020; 15: 88-92Crossref (6) 4Balkhy H.H. Kitahara H. First human totally endoscopic robotic-assisted replacement.Ann 109: e9-e11Abstract Full Text PDF (10) 5Vola Fuzellier J.-F. Campisi S. Faure Bouchet J.B. Sandri al.Totally (TEAVR).Ann 2015; 4: 196-197PubMed because rather than medial it summarizes large growing compared have been largely or small series. want amplify several distinct advantages offered novel described,1Badhwar which adapts “mini”-thoracotomy “working port” incision used many mitral surgery rAVR. First, spares pectoralis major, latissimus dorsi, right internal mammary artery; minimizes size working port incision; increases space anteromedial approaches. It can reduce eliminate need rib-spreading. Thus, may benefit from enhanced recovery has demonstrated use surgery.6Gammie J.S. Zhao Y. Peterson E.D. O'Brien S.M. Rankin Griffith B.P. Less-invasive operations: trends outcomes Society Thoracic Surgeons Adult Cardiac Surgery database.Ann 2010; 90: 1401-1410.e1Abstract (260) Totally techniques without thoracotomy feasible done few centers surgery, including ours, we feel will also provide additional over nonrobotic mini-thoracotomy AVR. Second, variety tailored patient-specific needs. offers advantage current AVR transcatheter (TAVR), narrow scope valves lack long-term durability data. must be appreciated both surgeons consideration nonsternotomy approaches available particularly given concern among related TAVR low-risk patient population. Also, there whom tissue not ideal, such as those complex bicuspid who mechanical prosthesis. certain populations. At present, 14% all repair operations performed robotically7Gammie Chikwe Thibault D.P. Vemulapalli Thourani V.H. al.Isolated surgery: database analysis.Ann 2018; 106: 716-727Abstract (141) same described report. familiar abbreviate learning curve these surgeons, making earlier adoption more feasible. The opportunity learn apply similar motivate cardiac invest time, energy, resources required develop skills needed techniques. Ultimately, relatively high-volume limit at time. state most challenging technical segment was aortotomy closure. There certainly solutions problem, but clear performing procedure. Although reported paper, challenges inadequate instrumentation necessary debridement heavily calcified leaflets3Nagaoka Scholar,4Balkhy described. found potential significant problem. Innovation critical evolution specialty. As noted Joseph Bavaria's 2017 Presidential Address Surgeons, community cannot shirk its responsibility continually advance practice devices, approaches, indications treatment.8Bavaria J.E. Quality innovation cardiothoracic colliding imperatives?.Ann 1276-1282Abstract (4) commended their ingenuity ability bring patients. replacementThe Journal Cardiovascular SurgeryVol. 161Issue 5PreviewThe management disease benefited substantially introduction international deemed prohibitive, high, intermediate risk.1-3 rate recently eclipsed (SAVR), volume SAVR continues grow incrementally any increase beyond 2% risk-adjusted mortality.4 Despite recent trials leading US regulatory approval,5,6 controversy remains best longitudinal option low risk. Full-Text