Transcervical Robotic Aortic Valve Replacement: A Possible New Frontier in Cardiac Surgery?

Abstract

From the first aortic valve replacement (AVR) in 1960, surgical approaches evolved toward reduction of surgical invasiveness and enhanced recovery. Conventional minimally invasive approaches still require postoperative opioid use and chest restrictions. To further minimize aortic valve surgery, a robotic technique for transcervical AVR (TC-AVR) was developed to avoid major chest wall incisions and to facilitate expedited recovery. Following extensive cadaver simulations, the TC-AVR was performed in 7 patients between March and July 2025. The procedure includes cervical incision, similar to a thyroidectomy approach, representing a working port for robotic AVR. Cardiopulmonary bypass is established with femoral cannulation. After native valve excision, a conventional prosthetic valve is implanted with a running suture technique. Patients (mean age, 66 ± 8 years; 71% male) presented mostly with severe aortic stenosis, whereas a bicuspid aortic valve was present in 57%. Mean aortic cross-clamp and cardiopulmonary bypass times were 118 and 218 minutes, respectively, with reductions observed in later cases. There was no postimplantation aortic regurgitation, and intraoperative peak and mean gradients were 10 ± 5 mm Hg and 5 ± 2 mm Hg, respectively. There were no deaths. Postoperatively, no opioids were required for patients not needing reoperation (uncomplicated cases; n = 5), with mean in-hospital stay of 3.2 days (2-4 days). Patients resumed daily activities soon after discharge, unrestricted by chest precautions. Robotic TC-AVR is feasible, with the potential to offer superior patient recovery compared with traditional approaches. Accordingly, continued development of this technique and specialized instrumentation along with further safety evaluation are warranted and should be actively pursued.