Robotic total endoscopic sutureless aortic valve replacement: proof of concept for a future surgical setting.
BACKGROUND
Sutureless valves have recently enabled closed chest aortic valve replacement. This paper evaluates the feasibility of a robotic telemanipulation during thoracoscopic sutureless aortic valve implantation in cadavers.


METHODS
Cadavers were prepared with a five thoracosopic trocar setting, with a transthoracic clamp inserted in the first right intercostal space and the optics inserted in the second. Seven sutureless valve implantations were scheduled using 5 Sorin Perceval and 2 Medtronic 3f Enable valves.


RESULTS
In all cases performance of pericardial suspension, aortotomy and root exposure required less than 20 min. Native valve excision and sutureless bioprosthesis implantation was technically feasible in all cases. A satisfactory prosthesis sealing was ascertained visually and the absence of paravalvular leakages was assessed with a nerve hook test around the prosthetic flange.


CONCLUSIONS
Closed chest and robot assisted sutureless valve implantation is feasible in cadavers. Robotic technology can enhance reproducibility of the technique. Copyright © 2015 John Wiley & Sons, Ltd.
Cardiovascular Surgery Unit, Cardiovascular Diseases Department, University Hospital, St- Etienne, France.
Marco
M
Vola
Cardiovascular Surgery Unit, Cardiovascular Surgery Unit, University Hospital of Lorraine, Nancy, France.
Pablo
P
Maureira
Cardiovascular Surgery Unit, Cardiovascular Diseases Department, University Hospital, St- Etienne, France.
Radwan
R
Kassir
Cardiovascular Surgery Unit, Cardiovascular Diseases Department, University Hospital, St- Etienne, France.
Jean-François
JF
Fuzellier
Cardiovascular Surgery Unit, Cardiovascular Diseases Department, University Hospital, St- Etienne, France.
Salvatore
S
Campisi
Cardiovascular Surgery Unit, Cardiovascular Diseases Department, University Hospital, St- Etienne, France.
Fabien
F
Doguet
Cardiovascular Surgery Unit, Cardiovascular Diseases Department, University Hospital, St- Etienne, France.
Jean-Noel
JN
Albertini
Cardiovascular Surgery Unit, Cardiovascular Diseases Department, University Hospital, St- Etienne, France.
Vito Giovanni
VG
Ruggieri
Cardiovascular Surgery Unit, Cardiovascular Surgery Unit, University Hospital of Lorraine, Nancy, France.
Thierry
T
Folliguet
D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis; D004724:Endoscopy; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D065287:Robotic Surgical Procedures / Q000379:methods*; D013537:Sutures
TAVI; aortic valve; minimally invasive surgery; robotic surgery; sutureless bioprosthesis