Innovations in robotic aortic valve surgery

This review explores the contemporary minimally invasive strategies in management of aortic valve disease, highlighting the innovative advancements in robotic approaches, particularly right transaxillary robotic aortic valve replacement (RAVR).

Over the past two decades, there has been increasing interest by patients and providers for less invasive alternatives to conventional sternotomy for treatment of aortic valve disease. Such strategies include transcatheter and minimally invasive surgical approaches such as mini-sternotomy, right anterior thoracotomy and robotic-assisted techniques. A major milestone was achieved in January 2020 with the introduction of RAVR, utilizing the established right transaxillary lateral 3 cm mini-thoracotomy platform commonly used for robotic mitral surgery.

RAVR provides a nonsternotomy, rib-sparing surgical option that offers the longitudinal benefits of conventional surgical aortic valve replacement (SAVR). As transcatheter aortic valve replacement (TAVR) expands into nonprohibitive risk populations, RAVR may provide similar minimally invasive advantages yet with the added benefit of comprehensive therapy to include concomitant procedures, particularly in low and intermediate surgical risk patients. Importantly, RAVR has facilitated a transformative advance in cardiac surgery, providing a platform for nearly all cardiac surgery with progressive complexity.