Surgeons have successfully performed the world’s first series of transcervical robotic aortic valve replacement (AVR) procedures on four patients.
All patients returned to full activity within a week, experiencing minimal pain and no complications related to the chest incisions.
Recovery was notably rapid. With only acetaminophen and ibuprofen for pain relief, patients were able to return to normal activities without restrictions – one patient even ran on a treadmill within a week. Another resumed farm work by the third postoperative week.
The pioneering operations, led by Marijan Koprivanac at Cleveland Clinic, were announced in a presentation at the American Association for Thoracic Surgery (AATS) annual meeting.
According to Dr Koprivanac, this marks the first known clinical application of transcervical robotic AVR, an approach that had previously only been tested in cadaver studies.
‘We are optimistic that this strategy could be a breakthrough for offering the benefits of surgical AVR without the lengthier and more painful recovery associated with current options.’
Surgical aortic valve replacement (SAVR) has undergone significant evolution in recent years.
While a full sternotomy remains the gold standard for some surgical candidates, new less-invasive techniques – including mini-sternotomy, right anterior thoracotomy, and robotic-assisted methods – are increasingly preferred.
Dr Koprivanac’s novel approach introduces a transcervical route, entering through a small neck incision instead of the chest, combined with robotic tools for precision and minimal tissue disruption.
This method builds on his earlier training with transcervical thymectomies and was developed over the course of extensive cadaver work at the Cleveland Clinic Lerner Research Institute, where he and his team refined the technique using custom retractors and robotic instrumentation.
The four patients, aged 60 to 74, received either a Perceval L or Inspiris Resilia valve, with an average cross-clamp time of 140 minutes. Hospital discharge occurred within three to six days – even for one patient who required a pacemaker due to postoperative heart block.
‘These types of activities are unimaginable so soon after other AVR approaches, even minimally invasive ones,’ Dr Koprivanac noted.
Cleveland Clinic leaders hailed the breakthrough.
Marc Gillinov, chair of Thoracic and Cardiovascular Surgery, stated that it was a significant advance in cardiac surgery.
Samir Kapadia, chair of Cardiovascular Medicine, said: ‘Patients may prefer this surgery if it delivers similar safety and efficacy as other, more-invasive surgeries.’
As experience grows, the team is focused on reducing cross-clamp time to 90 minutes or less and designing specialised instruments and sutures for tight-space manoeuvring.
While early results are promising, Dr Koprivanac emphasised a measured pace that prioritises patient safety. He anticipates the potential for discharge as early as day two post-surgery once the process is streamlined.
