Wei Lawrence M, Pereda Daniel, Ramzy Danny, Khaliel Feras H, Murtaza Ghulam, Mehaffey James Hunter, Chi Nai-Hsin, Poffo Robinson, Černý Štěpán, Vojáček Jan, Yan Tristan D, Melnitchouk Serguei, Weber Alberto C, Smith Robert L, Raikar Goya V, Darehzereshki Ali, Geirsson Arnar, Arghami Arman, Navia Jose L, Bonatti Johannes, Badhwar Vinay
Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV, USA.
Department of Cardiovascular Surgery, University of Barcelona, Barcelona, Spain.
Eur J Cardiothorac Surg. 2025 Mar 28;67(4). doi: 10.1093/ejcts/ezaf103.
In an effort to maintain the technical aspects of traditional prosthetic surgical aortic valve replacement (AVR) while reducing invasiveness and facilitate options for concomitant operations, transaxillary lateral mini-thoracotomy endoscopic robotic-assisted aortic valve replacement (RAVR) has been introduced. The present data highlight the contemporary international collaborative experience.
All consecutive patients undergoing standardized RAVR across 10 international sites (1/2020-7/2024) were evaluated using a central database with 1 year follow-up.
A total of 300 patients were analysed with a median predicted risk of 1.6% with aortic stenosis in 85.7%, nearly half with bicuspid valves. Biological prostheses were implanted in 220 (73.3%) with a median valve size 23 mm, 10% receiving aortic root enlargement, with 17% of all patients undergoing concomitant procedures. Median cross-clamp 120 min with no conversions to sternotomy. Median length of stay was 5 days, 4.3% with prolonged ventilation, 1.7% renal failure, 1.0% stroke and 8.3% required re-thoracotomy for evacuation of haemothorax. There were two 30-day operative mortalities (0.7%). The new permanent pacemaker rate for the full cohort was 2.6%. Of 163 patients with complete 1-year clinical and echocardiographic follow-up, mean aortic valve gradient was 10 mmHg and all but 2 patients (1.2%) had trace to no prosthetic or paravalvular insufficiency.
RAVR is safe and effective, providing the reproducible benefits of surgical AVR while affording a less invasive approach that permits the opportunity for concomitant procedures. For low and intermediate risk patients with aortic valve disease, RAVR is a potential reproducible alternative for patients and heart teams.
为了在保留传统人工心脏瓣膜置换术（AVR）技术特点的同时，减少手术创伤并为同期手术提供更多选择，经腋外侧小切口内镜机器人辅助主动脉瓣置换术（RAVR）应运而生。本文展示了当代国际合作经验。
对10个国际中心（2020年1月至2024年7月）连续接受标准化RAVR手术的所有患者进行评估，并通过中央数据库进行为期1年的随访。
共分析了300例患者，主动脉瓣狭窄的预测风险中位数为1.6%，其中85.7%为主动脉瓣狭窄，近一半患者为二叶式主动脉瓣。220例（73.3%）植入了生物瓣膜，瓣膜大小中位数为23mm，10%的患者接受了主动脉根部扩大术，17%的患者接受了同期手术。主动脉阻断时间中位数为120分钟，无中转开胸病例。住院时间中位数为5天，4.3%的患者通气时间延长，1.7%的患者出现肾衰竭，1.0%的患者发生中风，8.3%的患者因胸腔积血需要再次开胸。30天手术死亡率为2例（0.7%）。整个队列的新永久性起搏器植入率为2.6%。在163例完成1年临床和超声心动图随访的患者中，平均主动脉瓣压差为10mmHg，除2例患者（1.2%）外，其余患者均无人工瓣膜或瓣周漏。
RAVR安全有效，在提供手术AVR可重复获益的同时，提供了一种侵入性较小的方法，为同期手术提供了机会。对于中低风险的主动脉瓣疾病患者，RAVR是患者和心脏团队的一种潜在可重复选择。
