Innovation Update: Robotic Aortic Valve Replacement

Although surgeons have been performing robotic mitral valve repair and replacement for over twenty years, treatment for aortic valve disease has primarily been done with surgical aortic valve replacement (SAVR) via median sternotomy and, more recently, with transcatheter aortic valve replacement (TAVR) using a percutaneous approach. Over the last five years, however, robotic aortic valve replacement has begun to emerge as a viable option for patients as more surgeons from the United States and around the world have learned from one another and mastered the technique.

Dr. Vinay Badhwar, the Executive Chair of the WVU Heart & Vascular Institute in Morgantown, West Virginia, has been at the forefront of this surgical innovation and continues to collaborate with surgeons worldwide as the technology advances. Adam Pick, the founder of HeartValveSurgery.com, met with Dr. Badhwar at the Endoscopic Cardiac Surgeons Club Meeting in Northern Kentucky to learn more about this exciting new surgical technique for aortic valve replacement.

The Latest Developments in Robotic Aortic Valve Replacement

Here are the key insights shared by Dr. Badhwar:

• Patients in the community often ask about the latest updates regarding robotic aortic valve replacement (RAVR). “First of all, I am delighted that your patients and your colleagues are asking about robotic AVR,” said Dr. Badhwar. “Our goal was to develop another option for patients besides having a sternotomy, anterior chest approach, or a transcatheter valve. The robotic option gives the same outcome as a regular surgical aortic valve. It has lots of evidence for long-term survival, low morbidity, and fewer problems over the lifespan of the patient.”

• What has been achieved since the first surgical case? “We did our first case in January of 2020,” said Dr. Badhwar. “That was a collaboration, not just among our surgical team, but also our transcatheter cardiologists who wanted to have another option for the low to intermediate risk patients, particularly those who are younger than age 80. Since January 2020, after treating the first 200 patients, we’ve opened this up to the rest of the world. We’re very pleased to have a close collaboration with many of the surgeons here today and others around the world. There have now been nearly 400 patients who have received this therapy. After commencing this at WVU, there has been significant overall development, and the outcomes have been truly outstanding. Our key focus is to make this safe, standardized, and reproducible.”

• In terms of when you’re using the robot, is it isolated to a robotic AVR, or has its ability for other treatments widened over the years? “That’s a very important question,” said Dr. Badhwar.” “There are many options for treating patients with valvular heart disease. Transcatheter therapy is a single therapy, or a TAVR or TAVI, to treat the aortic valve. But many of our patients have other things like atrial fibrillation, mitral valve disease, et cetera. While we can do isolated robotic aortic valve replacement or repair, the whole reason we wanted to develop this through a tiny right lateral mini thoracotomy incision is to be able to use the same approach we use for standardized mitral valve surgery.” Dr. Badhwar explained that up to a third of the patients they treat don’t just need treatment for aortic valve disease. They also need treatment for mitral valve disease, atrial fibrillation, and other problems that go along with valvular disease. “We feel strongly that this is now a platform, not just for isolated aortic valve disease, but for all cardiac and multiple valvular surgeries.”

• Is the robotic AVR for a mechanical valve or for a tissue valve? “Using a very standardized surgical treatment, we cut out the valve and sew on a brand new one. It can either be a biologic valve made of cow or pig tissue, or a mechanical valve. There have been excellent outcomes for both,” explained Dr. Badhwar.

• What is the next step for sharing this information with physicians here and around the world? “We’ve worked this up in a very transparent way,” said Dr. Badhwar. “Innovation in isolation remains in isolation. Innovation as a collaboration becomes permanent. At least we hope. Starting in 2022, shortly after our initial experiences, we invited surgeons from around the world to co-develop and share their experiences. Last year, at the European Association for Cardiothoracic Surgery, we published our results for the first 300 patients. This was an international collaboration with multiple sites around the United States and Europe. Now, it has culminated in over 400 patients, and we are hosting another international valve meeting in Morgantown on November 13^th and 14^th. It’s called the International RAVRs Symposium, where surgeons and cardiologists will hopefully share ideas and their own experiences, and how to make this a better therapy for all our patients.”

Thanks Dr. Badhwar and WVU Heart and Valvular Institute!

On behalf of all the patients in our community, thank you, Dr. Vinay Badhwar, for everything you and your team are doing at the WVU Heart and Valvular Institute in Morgantown, West Virginia!

Related links:

• See Dr. Badhwar’s Interactive Surgeon Profile
• Badhwar: Top 3 Mitral Valve Repair Innovations
• Explore the WVU Heart and Vascular Institute Microsite

Keep on tickin,
Adam

P.S. For the deaf and hard-of-hearing members of our patient community, we have provided a written transcript of our interview with Dr. Badhwar below.