Robotic Aortic Valve Replacement: First 50 Cases.

Abstract Background Existing management challenges in selecting transcatheter versus surgical aortic valve replacement (SAVR) include bicuspid stenosis, low clinical risk, horizontal valve position, aortic insufficiency (AI), and need for concomitant procedures or mechanical valves. To address these gaps, we present our early experience with fully robotic-assisted aortic valve replacement (RAVR). Methods Between January 2020 and February 2021, 50 consecutive RAVR operations were performed utilizing a 3-4 cm lateral mini-thoracotomy three-port technique with transthoracic aortic clamping, similar to our robotic mitral platform. Conventional SAVR prostheses were implanted with interrupted braided sutures in all cases. Results Median age was 67.5 years, BMI was 29, calcified bicuspid disease was present in 28/50 (56%), and severe AI in 8/50 (16%). Ejection fraction was 54.8±8.4% (mean±SD), and STS PROM was 1.54±0.7%. Mechanical prostheses were used in 16/50 (32%), and 7 required concomitant procedures including Cox-Maze (3), left atrial appendage clipping (1), aortic root enlargement (2), mitral repair (1), and left atrial myxoma excision (1). Median times for cardiopulmonary bypass, cross-clamp, valvectomy, annular sutures, and aortotomy closure were 166, 117, 4, 20, and 31 minutes, respectively. All times plateaued after the initial five cases. Most patients (42/50, 84%) were extubated in the operating room, and the remainder (8/50, 16%) within 4 hours. There was no 30-day operative mortality or stroke. All had 30-day echocardiography demonstrating no valvular or perivalvular abnormalities. Conclusions RAVR appears to have procedural safety and short-term outcomes to rival alternatives. Incremental experience may facilitate the safe performance of concomitant procedures as deemed necessary.