February 2025 | Issue 76
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3 STS 2025
New data on aortic valve selection
13 SCOT-HEART Ten-year results of landmark CCTA trial
16 Profile
Bruno Scheller
Studies add fuel to debate over choice of surgical or transcatheter strategies in dual treatment of aortic and coronary disease
Pioneering procedures promise new era for robotic cardiac surgery A series of world-first robotic procedures performed in recent months have pushed the boundaries of possibility for robotics in the cardiac surgery arena and demonstrate the potential to broaden the availability of these procedures worldwide, experts in robotic surgery have said.
R
Spotlight on valve underexpansion
STS 2025
ROBOTICS
ecent advancements include the first ever fully robotic heart transplant, performed by surgeons at the King Faisal Specialist Hospital and Research Centre (KFSHRC, Riyadh, Saudi Arabia), whilst surgeons at West Virginia University (WVU, Morgantown, USA) have claimed their own milestone with a pioneering fully robotic procedure combining aortic valve replacement with coronary bypass grafting. Cardiac surgeon Feras Khaliel, the head of cardiac surgery and director of the Robotics and Minimally Invasive Surgery programme at KFSHRC led the heart transplant procedure in September 2024, which involved a 16-year-old patient suffering from end-stage heart failure. KFSHRC has gone on to claim a subsequent milestone by performing the first robotic-assisted implantation of a HeartMate 3 (Abbott) artificial heart pump, which was offered to a 35-year-old man who had been hospitalised for 120 days due to advanced heart failure in January 2025. Khaliel says that the use of robotic technology facilitates a minimally invasive approach that should theoretically shorten recovery time and improve quality of life for patients. Following the implantation of the HeartMate 3 heart pump, for example, the patient spent four days in the intensive care unit, in contrast to the 26-day average for similar procedures performed
19 ACURATE IDE
with traditional surgical methods. “Robotic cardiac surgery has transformed patient outcomes through its minimally invasive techniques, which reduce trauma, pain, and recovery times,” Khaliel tells Cardiovascular News. “Hospital stays are shortened by over 50%, and patients experience fewer complications and reduced reliance on blood transfusions. Procedures like robotic heart transplants take just two and a half hours, compared to six–12 hours with traditional methods.” KFSHRC is looking to position itself as world leader in robotic cardiac surgery and in 2024 performed over 1,127
Robotic cardiac surgery has transformed patient outcomes through its minimaly invasive techniques.”
A LARGE-SCALE ANALYSIS of data from the US Centers for Medicare and Medicaid Services (CMS) inpatient database, including over 37,000 patients with significant coronary artery disease requiring aortic valve replacement and coronary revascularisation, has found that patients fared better in the long term when they were treated with a surgical approach compared to transcatheter techniques. The analysis, presented by J Hunter Mehaffey (West Virginia University, Morgantown, USA) at the Society of Thoracic Surgeons’ (STS) 2025 annual meeting (25–27 January, Los Angeles, USA) is the latest in a series of studies attempting to establish the optimal approach for the treatment of patients presenting with concomitant aortic and coronary disease, with contrasting results—prompting calls for more randomised data to settle the question. “Very frequently during our structural heart conference we’re faced with patients who are low-risk candidates by STS risk score, who are being presented for severe aortic stenosis needing an aortic valve replacement. Based on the current data many of us believe there is equipoise about what approach is best in a low-risk patient,” Mehaffey tells Cardiovascular News, outlining the rationale for the research. “If they have concomitant disease that plays a role because there are treatment options that we can provide surgically in patients who have coronary disease.” The analysis by Mehaffey and colleagues evaluated patients aged 65 years and older with a diagnosis of coronary artery disease present on admission undergoing coronary artery Continued on page 2
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