Combining robotics with a transcervical approach offers an even less-invasive option. Cleveland Clinic
In a surgical first, doctors have replaced a heart valve through a small neck incision using robotic assistance, avoiding the need to open the chest.
The pioneering procedure, performed at the Cleveland Clinic by cardiothoracic surgeon Dr. Marijan Koprivanac, marks the first known clinical use of transcervical robotic access for aortic valve replacement (AVR).
Four patients underwent the technique earlier this year and were discharged within days.
One even resumed gym workouts just a week after surgery, according to a press release.
“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,” said Dr. Koprivanac.
Traditional AVR typically involves opening the chest via sternotomy, a method that significantly prolongs recovery and increases postoperative discomfort.
Less-invasive approaches like mini-sternotomy and right anterior thoracotomy have helped reduce trauma, but the transcervical approach takes this a step further by eliminating chest incisions altogether.
Illustration showing placement of the four incisions in transcervical robotic AVR. Credit- Cleveland Clinic
This method uses a robotic system inserted through a small incision along a natural neck crease, a technique adapted from robotic thymectomy.
The robotic arms allow for enhanced precision, visualization, and control within the narrow space around the aortic valve. Through four small incisions, surgeons can debride the diseased native valve and implant a new prosthetic one.
Recovery has been notably fast. All four patients reported low pain levels, managed primarily with acetaminophen and ibuprofen. One patient resumed farming within three weeks, while another returned to running just one week post-operation.
The technique builds on Dr. Koprivanac’s earlier experience with transcervical thymectomy, which also accesses the thoracic cavity via the neck.
He refined the AVR approach using cadavers in the Cleveland Clinic’s Lerner Research Institute, initially with a mammary retractor and later with a custom-designed transcervical retractor. After proving feasibility in about 20 cadavers, the team began offering the procedure to carefully selected patients needing isolated AVR.
Fast recovery, bold future
In the initial four cases, the average cross-clamp time was approximately 140 minutes.
Aged between 60 to 74 years, three patients received the Inspiris Resilia valve, while one received the Perceval L.
Most were discharged within 3 to 4 days, but for one patient, who developed postoperative heart block requiring a pacemaker, was discharged on day 6.
Dr. Koprivanac believes cross-clamp time will drop as the team gains experience and further refines the procedure.
Artist’s simulation of a transcervical robotic AVR procedure. The new aortic valve is being sutured into the aortic annulus. Credit- Cleveland Clinic
“With experience, we are refining techniques — such as optimal port placement and level of valve introduction — and becoming more efficient. As we have proved the safety of the procedure, reducing cross-clamp times is the main goal now,” he said.
The surgeons are working to shorten cross-clamp time to 90 minutes, with a long-term goal of reaching the one-hour mark.
To support this goal, the team is developing new instruments and adapting sutures that better suit the tight anatomical workspace. They also believe some patients may be eligible for discharge as early as postoperative day two, a potential milestone in accelerating surgical AVR recovery.
For now, the procedure is being performed exclusively at the Cleveland Clinic. However, the team hopes to standardize it for use at other highly specialized centers.
“This is a great advancement in minimally invasive surgical treatment for aortic stenosis,” said Dr. Samir Kapadia, Chair of Cardiovascular Medicine at Cleveland Clinic. “This surgery may be preferred by patients if it delivers similar safety and efficacy as other, more-invasive surgeries.”
With strong early outcomes and growing experience, Dr. Koprivanac and his colleagues believe transcervical robotic AVR could redefine what’s possible in heart surgery.
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