Not All SAVR Are Created Equal: All the Approaches Available for Surgical Aortic Valve Replacement

Area of Science:

• Cardiac Surgery
• Thoracic Surgery
• Minimally Invasive Surgery

Background:

• Surgical Aortic Valve Replacement (SAVR) remains a cornerstone of cardiac surgery.
• Increasing demand for less invasive procedures and competition from structural valve therapies drive innovation in SAVR.
• Traditional sternotomy SAVR is becoming less common, necessitating exploration of alternative approaches.

Purpose of the Study:

• To comprehensively review all surgical techniques for aortic valve replacement.
• To analyze the advantages, disadvantages, and key differences of various SAVR approaches.
• To provide guidance for surgeons in selecting the optimal SAVR technique based on patient anatomy and surgeon expertise.

Main Methods:

• Systematic review of existing literature on SAVR techniques.
• Analysis of surgical approaches including sternotomy, mini-sternotomy, right anterior thoracotomy, and minimally invasive robotic/endoscopic methods.
• Inclusion of a decision-making flow diagram to aid in technique selection and learning curve progression.

Main Results:

• Sternotomy SAVR, while historically standard, is declining in use.
• Mini-sternotomy offers broad applicability for minimally invasive access.
• Right anterior thoracotomy is effective but requires specialized skills; endoscopic and robotic techniques are emerging but not yet widely adopted.

Conclusions:

• The choice of SAVR approach depends on patient-specific anatomy and surgeon proficiency.
• Mastering multiple SAVR techniques is crucial for providing patient-tailored, safe, and minimally invasive surgical options.
• Continuous skill development is essential for advancing complex SAVR procedures.