Outcomes of robotically-assisted aortic valve surgery: A systematic review
Abstract
Introduction
Aortic valve disease is a noteworthy public health burden, with aortic valve surgery commonly being used to treat the condition. While aortic valve surgery is traditionally performed using an open approach involving median sternotomy, less invasive surgical methods have been developed over the years as an endeavour to improve surgical outcomes, such as the incorporation of robotic assistance. However, information and research regarding robotically-assisted aortic valve surgery remains scarce.
Methods
Through this original systematic review, which is the first of its kind, the outcomes of robotically-assisted aortic valve surgery were investigated. Ultimately, 26 papers involving a total of 362 cases were included in this study. Data items that directly relate to surgical outcomes were comprehensively recorded and tabulated.
Results
Analyses of the data demonstrated that robotically-assisted aortic valve surgery is a feasible procedure with apparent safety and a relatively low risk for complications and adverse events. However, the level of existing evidence remains low due to several limitations including a lack of existing literature and potential publication bias.
Conclusion
To accurately determine the safety profile of robotically-assisted aortic valve surgery and make meaningful comparisons between the procedure and other alternatives, future large-scale, multicenter cohort studies with comparators, or ideally randomised controlled trials followed by a meta-analysis of the results should be performed.
Get full access to this article
View all access and purchase options for this article.
Data availability statement
Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.*
References
1. Aluru JS, Barsouk A, Saginala K, et al. Valvular heart disease epidemiology. Med Sci 2022; 10(2): 32.
2. Al-Adhami A, Al-Attar N. Recent advances in aortic valve replacement for aortic stenosis. F1000Res 2016; 5: F1000. https://doi.org/10.12688/f1000research.8728.1
3. Pujari SH, Agasthi P. Aortic stenosis. In: StatPearls. Treasure Island (FL). StatPearls Publishing, 2023.
4. Osnabrugge RL, Mylotte D, Head SJ, et al. Aortic stenosis in the elderly: disease prevalence and number of candidates for transcatheter aortic valve replacement: a meta-analysis and modeling study. J Am Coll Cardiol 2013; 62(11): 1002–1012. https://doi.org/10.1016/j.jacc.2013.05.015
5. Amabile A, Komlo CM, Guy TS. Showcasing the lateral approach for robotic aortic and mitral valve surgery: does one approach fit it all? J Card Surg 2021; 36(10): 3860–3861. https://doi.org/10.1111/jocs.15782
6. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372: n71. https://doi.org/10.1136/bmj.n71
7. Whiting P, Savović J, Higgins JP, et al. ROBIS: a new tool to assess risk of bias in systematic reviews was developed. J Clin Epidemiol 2016; 69: 225–234. https://doi.org/10.1016/j.jclinepi.2015.06.005
8. Granholm A, Alhazzani W, Møller MH. Use of the GRADE approach in systematic reviews and guidelines. Br J Anaesth 2019; 123(5): 554–559. https://doi.org/10.1016/j.bja.2019.08.015
9. Rosen JL, Yost CC, Wong DH, et al. Routine endoscopic robotic cardiac tumor resection using an 8‐mm working port and percutaneous cannulation. J Card Surg 2022; 37(12): 4803–4807. https://doi.org/10.1111/jocs.17166
10. Arai A, Kitahara H, Balkhy HH. Robotic totally endoscopic aortic valve replacement with a sutured bioprosthesis. Multimed Man Cardiothorac Surg 2024; 2024: https://doi.org/10.1510/mmcts.2024.071
11. Badhwar V, Wei LM, Cook CC, et al. Robotic aortic valve replacement. J Thorac Cardiovasc Surg 2021; 161(5): 1753–1759.
12. Badhwar V, Pereda D, Khaliel FH, et al. Outcomes following initial multicenter experience with robotic aortic valve replacement: defining a path forward. J Thorac Cardiovasc Surg 2024; 167(4): 1244–1250. https://doi.org/10.1016/j.jtcvs.2024.01.020
13. Badhwar V, Raikar GV, Darehzereshki A, et al. Robotic-assisted aortic valve replacement and coronary artery bypass grafting. Ann Thorac Surg 2025; 119(4): 918–922. https://doi.org/10.1016/j.athoracsur.2024.12.002
14. Badhwar V, Darehzereshki A, Raikar GV, et al. Robotic-assisted transcatheter aortic valve explantation and aortic valve replacement. Ann Thorac Surg 2025; 120(5): 983–987. https://doi.org/10.1016/j.athoracsur.2025.07.014
15. Balkhy HH, Kitahara H. First human totally endoscopic robotic-assisted sutureless aortic valve replacement. Ann Thorac Surg 2020; 109(1): e9–e11. https://doi.org/10.1016/j.athoracsur.2019.04.093
16. Balkhy HH, Lewis CTP, Kitahara H. Robot-assisted aortic valve surgery: state of the art and challenges for the future. Int J Med Robot 2018; 14(4): e1913. https://doi.org/10.1002/rcs.1913
17. Darehzereshki A, Wei LM, Comas G, et al. Feasibility and safety of robotic aortic root enlargement in conjunction with robotic aortic valve replacement. JTCVS Tech 2023; 22: 178–180. https://doi.org/10.1016/j.xjtc.2023.09.023
18. Ishikawa N, Watanabe G, Koakutsu T, et al. Robotic surgery for triple valve insufficiency: a case report. Innovations 2023; 18(4): 380–383. https://doi.org/10.1177/15569845231185394
19. Jagadeesan V, Mehaffey JH, Darehzereshki A, et al. Robotic aortic valve replacement vs transcatheter aortic valve replacement: a propensity-matched analysis. Ann Thorac Surg 2025; 120(1): 62–70. https://doi.org/10.1016/j.athoracsur.2024.10.013
20. Khaliel FH, Al Aboud MS, Fallatah FA, et al. Robotic aortic valve replacement in the Middle East: reproducibility into practice with evolving complexity. Ann Cardiothorac Surg 2025; 14(3): 202–209. https://doi.org/10.21037/acs-2024-ravr-0195
21. Kitahara H, Nisivaco S, AlJamal Y, et al. Combined robotic endoscopic aortic valve replacement and robotic totally endoscopic coronary bypass: dual case report with 3-Year Follow-Up. Innovations 2025; 20(1): 109–110. https://doi.org/10.1177/15569845241313465
22. Kitahara H, Nisivaco S, Al Jamal Y, et al. Robotic endoscopic aortic valve replacement with rapid deployment valve: technique and outcomes. Ann Cardiothorac Surg 2025; 14(3): 244–246. https://doi.org/10.21037/acs-2025-ravr-10
23. Nagaoka E, Gelinas J, Vola M, et al. Early clinical experiences of robotic assisted aortic valve replacement for aortic valve stenosis with sutureless aortic valve. Innovations 2020; 15(1): 88–92. https://doi.org/10.1177/1556984519894298
24. Napoli F, Aleman R, Montero O, et al. Aortic valve papillary fibroelastoma: robotic excision and noncoronary aortic valve repair. Ann Thorac Surg Short Rep 2023; 1(4): 650–652. https://doi.org/10.1016/j.atssr.2023.07.008
25. Nisivaco SM, Patel B, Balkhy HH. Robotic totally endoscopic excision of aortic valve papillary fibroelastoma: the least invasive approach. J Card Surg 2019; 34(12): 1492–1497. https://doi.org/10.1111/jocs.14291
26. Pereda D, Sandoval E, Blanco O, et al. Robotic aortic valve replacement using the intuity bioprosthesis through a right lateral approach. Innovations 2022; 17(5): 442–444. https://doi.org/10.1177/15569845221125774
27. Sandoval E, Pereda D. Establishing a robotic aortic valve replacement program in Spain: growing opportunities for Europe. Ann Cardiothorac Surg 2025; 14(3): 218–224. https://doi.org/10.21037/acs-2025-ravr-0003
28. Sandoval E, Fernández-Cisneros A, García TA, et al. Robotic resection of an aortic valve fibroelastoma using a right lateral approach. J Card Surg 2021; 36(10): 3857–3859. https://doi.org/10.1111/jocs.15781
29. Sun J, Yuan Y, Song Y, et al. Early results of totally endoscopic robotic aortic valve replacement: analysis of 4 cases. J Cardiothorac Surg 2022; 17(1): 155. https://doi.org/10.1186/s13019-022-01899-3
30. Wei LM, Cook CC, Hayanga JWA, et al. Robotic aortic valve replacement: first 50 cases. Ann Thorac Surg 2022; 114(3): 720–726. https://doi.org/10.1016/j.athoracsur.2021.08.036
31. Wei LM, Darehzereshki A, Comas GM, et al. Robotic-assisted repair of aortic valve leaflet prolapse by cusp plication and annuloplasty. JTCVS Tech 2023; 21: 59–61. https://doi.org/10.1016/j.xjtc.2023.07.020
32. Wei LM, Pereda D, Ramzy D, et al. Longitudinal outcomes following international multicentre experience with robotic aortic valve replacement. Eur J Cardio Thorac Surg 2025; 67(4): ezaf103. https://doi.org/10.1093/ejcts/ezaf103
33. Wei LY, Chen JW, Chou NK, et al. Outcomes of robotic and endoscopic combined aortic and mitral valve surgery: experience from National Taiwan University hospital. Ann Cardiothorac Surg 2025; 14: 210–217. https://doi.org/10.21037/acs-2024-ravr-0185
34. Wong DH, Yost CC, Rosen JL, et al. Totally endoscopic robot-assisted aortic valve replacement and complex mitral valve repair: the lateral approach. Innovations 2022; 17(4): 355–357. https://doi.org/10.1177/15569845221106939
35. Yoshikawa Y, Kishimoto Y, Onohara T, et al. Robot-assisted aortic valve replacement - first clinical report in Japan. Circ J 2023; 87(6): 847–851. https://doi.org/10.1253/circj.CJ-23-0059
36. Murad MH, Asi N, Alsawas M, et al. New evidence pyramid. Evid Base Med 2016; 21(4): 125–127. https://doi.org/10.1136/ebmed-2016-110401
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
Cite
Cite
Cite
OR
Download to reference manager
If you have citation software installed, you can download citation data to the citation manager of your choice
Information, rights and permissions
Information
Published In
Article first published online: March 30, 2026
Keywords
Data availability statement
Data is available for this article. View more information
PubMed: 41910457
Authors
Metrics and citations
Metrics
Publication usage*
Total views and downloads: 18
*Publication usage tracking started in December 2016
Altmetric
See the impact this article is making through the number of times it’s been read, and the Altmetric Score.
Learn more about the Altmetric Scores
Publications citing this one
Receive email alerts when this publication is cited
Web of Science: 0
Crossref:
There are no citing articles to show.
Figures and tables
Figures & Media
Tables
View Options
Access options
If you have access to journal content via a personal subscription, university, library, employer or society, select from the options below:
I am signed in as:
View my profileSign out
I can access personal subscriptions, purchases, paired institutional access and free tools such as favourite journals, email alerts and saved searches.
loading institutional access options
AACP members can access this journal content using society membership credentials.
AACP members can access this journal content using society membership credentials.
Alternatively, view purchase options below:
Purchase 24 hour online access to view and download content.
Access journal content via a DeepDyve subscription or find out more about this option.
