Robotic Aortic Valve Replacement: A New Approach To An Old Problem
Faisal Abdulhaleem Fallatah, Feras Khaliel.
King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
BACKGROUND: In recent years the management of aortic valve pathology has changed significantly as more and more patients are being treated with transcatheter aortic valve replacement (TAVR) including low risk patients. Despite the advancement of TAVR, there still a group of patients who are in need of surgical aortic valve intervention. Over the last two decades robotic cardiac surgery has been proven to be a safe and effective tool in cardiac surgery. Robotic aortic valve replacement (RAVR) has been recently introduced and it appears to be safe and comparable to existing alternatives. METHODS: Between March 2022 and September 2022, 8 patients underwent RAVR, one of them had concomitant mitral valve repair. All procedures were done through a 4 cm right mini-thoracotomy plus three port robotic technique and peripheral cardiopulmonary bypass (femoral arterial access + femoro-jagular venous access). Standard surgical technique of valve implantation using interrupted braided pledgeted sutures was used on all patients. RESULTS: The median age of our 8 patients was 36.5 years and the average body mass index was 35 kg/m2. 75% of our group (6 patients) suffered from sever aortic insufficiency while the remaining two patients had sever aortic stenosis. The average ejection fraction was 50.5% with a mean society of thoracic surgeons (STS) score of 0.65%. CONCLUSIONS: The average cross clamp time was 145 minutes, and the median ventilation time was 5 hours with 3 patients extubated on the operating table. The median length of stay was 6.5 days, and the median blood transfusion was 1 unit of red blood cells. There were two patients left open for bleeding and had to be taken back to the operating room for haemostasis and closure. During the post operative period 2 patient had acute kidney injury but did not require dialysis and 1 patient developed post operative atrial fibrillation. There were no wound complications, strokes, or 30-day operative mortality. Follow up echocardiogram showed well-functioning valves and a reduction of left ventricular diastolic diameter of an average of 0.86 cm.
| Age | 36.6 (20-56) |
| Diabetes mellitus | 12.5(1) |
| Hypertension | 37.5(3) |
| Decompensated Heart Failure | 12.5(1) |
| Pre operative Atrial Fibrillation | 12.5(1) |
| Ejection Fraction | 50.5% |
| Aortic Valve Insufficiency | 6(75%) |
| Aortic Valve Stenosis | 2(25%) |
| Median Left ventricular Internal Diameter in Diastole, cm | 5.9 |
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