Global Advances in Robotic Heart Surgery: Valves, Coronary Bypass, and Transplantation (Up to 2025)
Global Advances in Robotic Heart Surgery: Valves, Coronary Bypass, and Transplantation (Up to 2025)
This review highlights the most significant global developments in robotic cardiac surgery, focusing on valve interventions, coronary artery revascularization, heart transplantation, and mechanical circulatory support. The summary is based on multiple peer-reviewed sources, with primary reference to MDPI (Micromachines, 2025) and supplemented by data from 2022–2025 reports and studies.
1. Valve Surgery
Robotic surgery is now a leading approach for heart valve interventions, offering minimal invasion, faster recovery, and durable results.
• Mitral Valve: The most common valve treated with robotic surgery worldwide. Surgeons perform repairs and replacements using high-definition 3D vision and precision instruments.
• Aortic Valve: Adopted in select centers using hybrid robotic–endoscopic methods to reduce surgical trauma.
• Tricuspid Valve: Robotic repair or replacement for severe regurgitation, often combined with mitral surgery, enabling accurate annuloplasty and leaflet reconstruction.
• Multi-Valve Surgery: Complex combinations (mitral + aortic + tricuspid) completed in a single minimally invasive procedure.
2. Coronary Artery Revascularization
Robotic systems have advanced coronary bypass surgery, maintaining high graft quality with smaller incisions.
• RA-MIDCAB: Robotic harvesting of the left internal mammary artery (LIMA) with mini-thoracotomy anastomosis.
• TECAB: Entirely endoscopic coronary artery bypass without sternotomy, performed in specialized centers.
• Hybrid Coronary Revascularization: Robotic LIMA-LAD bypass combined with PCI for other lesions, tailored to each patient.
• Approach: LIMA-LAD graft performed on day 0 under aspirin only (no P2Y₁₂ inhibitors to reduce bleeding). PCI with stent placement is done 3–5 days later after initial wound healing, followed by dual antiplatelet therapy (DAPT) according to current guidelines.
3. Heart Transplantation
• First Fully Robotic Heart Transplant: Achieved at King Faisal Specialist Hospital and Research Center (KFSHRC), Riyadh, in 2024.
• Benefits: Minimal surgical trauma, reduced infection risk, and faster recovery compared to conventional sternotomy.
4. Mechanical Circulatory Support (MCS)
• LVAD: First robotic-assisted HeartMate 3 implant at KFSHRC in January 2025.
• BiVAD: World’s first robotic-assisted biventricular assist device implantation in July 2025 at KFSHRC, using two HeartMate 3 devices for a patient with end-stage heart failure, non-eligible for transplant.
• Advantages: Lower infection risk, faster mobilization, and minimally invasive access.
KFSHRC Robotic Milestones:
1. 2024 – First fully robotic heart transplant.
2. Jan 2025 – First robotic-assisted LVAD implant.
3. July 2025 – First robotic-assisted BiVAD implant.
References:
1. Michael Walter, Cardiovascular Business, July 17, 2025.
2. Folliguet T., Ann Cardiothorac Surg, 2022.
3. Bonatti J., J Thorac Dis, 2022.
4. Raffa G., MDPI Micromachines, 2024.
5. Serruys P., Curr Cardiol Rep, 2023.
