Robotic Aortic Valve Replacement vs Transcatheter Aortic Valve Replacement: A Propensity-Matched Analysis

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Medical Technology

Background:

• Surgical aortic valve replacement (AVR) and transcatheter AVR (TAVR) are established options for symptomatic severe aortic stenosis (AS).
• The optimal treatment strategy for lower-risk patients remains debated.
• Minimally invasive robotic AVR (RAVR) has emerged as a potential alternative.

Purpose of the Study:

• To compare in-hospital and 1-year outcomes of robotic AVR (RAVR) versus transcatheter AVR (TAVR) in low- to intermediate-risk patients with severe symptomatic AS.
• To evaluate the safety and efficacy of RAVR as a minimally invasive approach.

Main Methods:

• A retrospective analysis of 605 consecutive patients undergoing AVR or TAVR between 2017 and 2023.
• Propensity matching was used to create comparable groups of 144 RAVR and 144 TAVR patients (STS predicted risk of mortality <8%).
• In-hospital and 1-year clinical outcomes were assessed.

Main Results:

• In-hospital and 30-day mortality were similar between RAVR and TAVR groups.
• The TAVR group experienced higher rates of new pacemaker implantation, major vascular complications, and a trend toward more postprocedural strokes.
• RAVR patients had a higher rate of reoperation for hemothorax evacuation, but TAVR was associated with significantly higher 1-year mortality and moderate-to-severe paravalvular leak.

Conclusions:

• Robotic AVR (RAVR) demonstrated lower rates of pacemaker and vascular complications compared to TAVR.
• RAVR was associated with significantly less 1-year paravalvular leak and lower 1-year mortality.
• RAVR represents a safe and effective minimally invasive alternative to TAVR for selected patients with severe symptomatic aortic stenosis.