Lateral access fully robotic aortic valve replacement "RAVR": from novel to normal

Right lateral access robotic aortic valve replacement (RAVR) may represent a significant advancement in minimally invasive cardiac surgery. This review examines RAVR's development, technical specifications, clinical outcomes, and future trajectory in cardiac surgery. Multicenter RAVR experiences have demonstrated promising results with low rates of operative mortality (0.9%), stroke (0.9%), and permanent pacemaker placement (2.9%). In propensity-matched comparisons with transcatheter aortic valve replacement (TAVR), RAVR had significantly lower rates of paravalvular leak (0.7% vs. 21.5%) and one-year mortality (1.4% vs. 12.5%). With a 3-cm working incision at the level of the anterior axillary line, the lateral access approach offers distinct advantages including improved surgical visualization, reduced tissue trauma, and standardization potential across various cardiac procedures. While learning curve considerations exist, these are minimal for experienced robotic mitral teams. RAVR programs have expanded to include implementation of complex procedures such as aortic root enlargement. As robotic systems become more prevalent and surgical expertise grows, RAVR shows promise to evolve from an innovative technique to a standard therapeutic option in aortic valve surgery. This evolution, supported by growing clinical evidence and technological advancement, positions RAVR as a potentially transformative development in cardiac surgery, offering patients the benefits of minimally invasive approaches while maintaining the durability of traditional surgical valve replacement.