OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Department of Cardiac Surgery University Hospital Hradec Kralove Czech Republic

Department of Cardiac Surgery University Hospital Motol Prague Czech Republic

Department of Cardiothoracic Surgery The Royal Prince Alfred Hospital Sydney Australia

Department of Cardiothoracic Surgery University of Pittsburgh Pittsburgh PA USA

Department of Cardiovascular and Thoracic Surgery West Virginia University Morgantown WV USA

Department of Cardiovascular Surgery Herzzentrum Hirslanden Zurich Switzerland

Department of Cardiovascular Surgery Hospital Israelita Albert Einstein Sao Paulo Brazil

Department of Cardiovascular Surgery Mayo Clinic Rochester MN USA

Department of Cardiovascular Surgery University of Barcelona Barcelona Spain

Department of Surgery National Taiwan University Hospital Taipei Taiwan

Department of Thoracic and Cardiovascular Surgery Cleveland Clinic Florida Weston FL USA

Division of Adult Cardiac Surgery Presbyterian Hospital Columbia University New York NY USA

Division of Cardiac Surgery Baylor Scott and White Health Plano TX USA

Division of Cardiac Surgery King Faisal Specialist Hospital and Research Center Riyadh Saudi Arabia

Division of Cardiac Surgery Massachusetts General Hospital Boston MA USA

Division of Cardiac Surgery McGovern Medical School UTHealth Houston TX USA

Division of Cardiothoracic Surgery SSM Health St Mary's Hospital Madison WI USA

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