Surgeons at the Cleveland Clinic have achieved a breakthrough by replacing a heart valve through a small cut in the neck without opening the chest. This first-of-its-kind surgery, led by Dr. Marijan Koprivanac, used robotic technology to perform what is now being called a game-changing procedure in heart treatment.
Four patients underwent the new surgery earlier this year, and all recovered quickly. One of them was even back in the gym just a week after the operation.
Aortic valve replacement is done by opening the chest through a process called a sternotomy. This involves cutting through the breastbone, which often leads to a long, painful recovery. Even the less invasive versions still require incisions through the ribs.
However, this new robotic procedure avoids all that by using the front of the neck as the entry point. It is based on an older technique called robotic thymectomy, but now adapted to reach and replace the aortic valve.
Dr. Koprivanac said, “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.” The new method uses four tiny incisions in the neck. Surgeons then guide robotic arms to remove the damaged heart valve and insert a new one.
The surgery is performed with extreme precision, and because there are no cuts to the chest, patients heal faster and with much less pain. All four patients who received the surgery only needed basic painkillers like Tylenol and ibuprofen during recovery.
One of the patients returned to farming just three weeks after the operation. Another started running only seven days later. Doctors discharged all patients from the hospital within a few days. One patient needed a pacemaker and left the hospital after six days. They leave the rest for three to four days.
Dr. Koprivanac and his team spent years preparing for this moment. They first practiced the technique using cadavers in the Cleveland Clinic’s Lerner Research Institute. They experimented with tools such as mammary retractors and later designed specialized instruments for the procedure. After proving it was safe and effective in about 20 cadaver models, they carefully selected real patients for the first surgeries.
Dr. Koprivanac explained, “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.”
The first four surgeries stopped the heart for about 140 minutes, a period known as cross-clamp time. The team now wants to reduce this to 90 minutes and eventually to 60. They are working on new tools and materials to help with this goal and hope to one day discharge patients as early as two days after surgery.
This robotic surgery could bring huge benefits to patients. The small neck incision hides easily; surgeons do not need to break any bones, and patients recover much faster with less pain. Patients can return to their normal lives more quickly than ever before.
Right now, only the Cleveland Clinic performs the procedure. Doctors hope that, with more experience and training, other hospitals will also use the method.
Dr. Samir Kapadia, Chair of Cardiovascular Medicine at Cleveland Clinic, said, “This is a great advancement in minimally invasive surgical treatment for aortic stenosis. Patients may prefer this surgery if it delivers safety and efficacy similar to other, more invasive surgeries.”
In the past, doctors have associated heart valve surgeries with long hospital stays, large scars, and difficult recoveries. But this new technique shows that things are changing. Robotic technology is giving doctors the power to do surgeries in safer, faster, and more comfortable ways.
