Robotic aortic valve replacement in the Middle East: reproducibility into practice with evolving complexity

Abstract

Background: Robotic aortic valve replacement (RAVR) has seen a rise in usage in recent years; however, follow-up data remain limited. This study aimed to assess the short- and mid-term clinical outcomes after RAVR.

Methods: This study included patients who underwent RAVR between 2022 and 2024. The primary outcomes were mortality and survival at follow-up. The secondary outcomes were hospital complications and echocardiographic parameters at follow-up.

Results: Fifteen patients underwent RAVR. The mean age was 38.6±14.4 years, and 86.7% were males. The median Society of Thoracic Surgery (STS) score was 0.6%. Isolated RAVR was performed in 66.7% of the patients (n=10), whereas five patients underwent concomitant surgery, including mitral valve repair (n=1), mitral valve replacement (n=3), and ascending aortoplasty (n=1). Mechanical valves were used in 10 patients (66.7%). The mean ischemic time was 150±33.9 min. No sternotomy conversion was required. The median length of hospital stay was 9 days [quartile (Q)1-Q3, 4-15 days]. Four patients had on-table extubation (26.7%). One patient required intensive care unit (ICU) readmission, and one patient was readmitted for pleural effusion. The median follow-up was 24 months (Q1-Q3, 15-29 months). No mortality was reported during this period. All patients were in New York Heart Association (NYHA) class I, except for one in NYHA II. There were no significant changes in left ventricular ejection fraction (LEVF) at the last follow-up compared with the preoperative value (P=0.741). However, the left ventricular end-diastolic diameter (LVEDD) was significantly lower at follow-up than preoperatively (P=0.003).

Conclusions: RAVR demonstrates promising short- and mid-term clinical outcomes. Its minimally invasive nature and the ability to use durable mechanical valves may offer potential advantages over traditional surgical and transcatheter approaches.

Keywords: Robotic; aortic valve disease; aortic valve replacement; minimally invasive surgery.

Figure 1

Ischemic time in patients with isolated and combined RAVR. The patients were arranged sequentially according to the surgery performed. RAVR, robotic aortic valve replacement.