Adult Cardiac

In today’s 11:30 a.m. session, "Robotic Cardiac Surgery: The Future Is Now," Dr. Tedy Sawma will discuss how mitral regurgitation, increasingly common in aging populations, presents unique challenges for older patients considering surgical treatment options. While mitral valve repair remains an effective solution, the invasiveness of traditional open-heart surgery often discourages both patients and healthcare providers.

In the Outcomes of Robotic Mitral Valve Repair in Patients Older Than 65 Years presentation, study investigators will highlight findings on robotic mitral valve repair in older patients, comparing outcomes with those from traditional median sternotomy. The study evaluates both short-term and long-term outcomes to determine whether robotic surgery offers advantages in recovery, quality of life, long-term survival, and the need for future interventions.

Researchers analyzed data from a cardiovascular surgery database, tracking patients who underwent their first isolated mitral valve repair between 2010 and 2024. They compared the outcomes of robotic procedures with those of traditional median sternotomy surgeries, adjusting for factors like age, gender, and comorbidities.

Primary outcomes included long-term all-cause mortality and the need for reinterventions, while secondary outcomes focused on hospital recovery metrics such as blood transfusions, atrial fibrillation rates, and ICU stay durations.

The findings to be discussed include how robotic mitral valve repair offered short-term advantages over traditional surgery, such as reduced ICU and hospital stays, fewer blood transfusions, and lower rates of postoperative atrial fibrillation. However, no significant differences were observed in long-term survival or the need for future interventions. Both groups maintained excellent physical activity levels and quality of life over the years. These results suggest that robotic mitral valve repair is a viable option for older patients, providing enhanced short-term recovery without compromising long-term outcomes.

During the Top Adult Cardiac Surgery Abstracts session on Sunday, Jan. 25, J. Hunter Mehaffey, MD, a cardiothoracic surgeon from West Virginia University, will examine results comparing two treatment options— Transcatheter vs. Surgical Aortic Valve Replacement in Medicare Beneficiaries with Aortic Stenosis and Significant Coronary Disease. The study aimed to assess the relative benefits of a surgical approach with CABG/SAVR vs a transcatheter approach with TAVR/PCI (elective +/- 3 months) and safety of these procedures, focusing on early and late outcomes such as mortality, complications, and hospital readmissions.

Dr. Mehaffey’s presentation will highlight the study’s findings that TAVR/PCI is associated with lower hospital mortality, bleeding, and kidney injury but higher incidence of new pacemaker and vascular complications compared to SAVR in this patient group. However, CABG/SAVR was associated with significantly lower longitudinal all-cause mortality and improved freedom from the composite of death, stroke, MI, or valve reintervention. Furthermore, subgroup analysis of single vessel coronary patients confirmed CABG/SAVR was associated with superior freedom from the composite of death, stroke, MI, or valve reintervention compared to PCI/TAVR particularly in surgical patients who received arterial grafts.  

This study uses real-world contemporary data highlighting the longitudinal benefits of a surgical approach compared to a transcatheter approach in patients undergoing aortic valve replacement with significant coronary disease. “These data provide important information to guide heart team discussion and decision making in patients needing aortic valve replacement,” said Dr Mehaffey.
 

A groundbreaking study to be presented at the 2025 Society of Thoracic Surgeons Annual Meeting sheds light on an important decision point for patients requiring aortic valve replacement. Utilizing data from the STS Adult Cardiac Surgery Database, researchers have delivered the most extensive analysis to date on the outcomes of prosthetic valve types for patients aged 60 and younger.

The study, to be presented by Dr. Michael Bowdish, Cedars-Sinai Medical Center, examines the impact of valve choice—mechanical versus bioprosthetic—on long-term survival. By linking patient-level data from the STS ACSD with the National Death Index, researchers offer fresh insights into the critical question of how age and valve type affect surgical outcomes.

With its rigorous methodology and focus on tailoring care to individual needs, the study underscores the potential of advanced surgical techniques and data analytics to improve patient outcomes. It also highlights the pivotal role of the STS National Database, which provides robust national benchmarks for cardiothoracic procedures in the US, in driving impactful research and clinical innovation.

In presenting the Adult Cardiac Clark Paper on day two of STS 2025, Increased Risk of Surgical Aortic Valve Replacement After Prior Transcatheter Versus Surgical Aortic Valve Replacement with Concomitant Valve Disease, Dr. Robert Hawkins explores the heightened mortality risk for patients undergoing reoperation after transcatheter aortic valve replacement (TAVR) compared to those who have undergone surgical aortic valve replacement (SAVR).

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Using data from the STS Adult Cardiac Surgery Database, which covers the years 2011 to 2021, Dr. Hawkins and his team examine the impact of concomitant mitral and tricuspid valve diseases on reoperation outcomes, with a particular focus on TAVR explants.

As part of the “Aortic Valve Surgery: What Do Our Patients Need to Know?” session on Saturday, Jan. 25 from 4:30 – 5:45 p.m., Dr. Hawkins will discuss findings that show patients with prior TAVR are more likely to suffer from severe concomitant valve diseases, such as mitral regurgitation, compared to those who underwent SAVR. These patients demonstrated a higher mortality rate during reoperation, particularly TAVR explants with an increase in the odds of mortality. The study further finds that severe valve disease is associated with significantly higher mortality in both TAVR explant and redo-SAVR cases.

During this session, Dr. Hawkins will share findings indicating that heart teams should consider these risks when deciding between TAVR and SAVR, as well as when addressing dysfunctional TAVR valves to avoid the heightened risks of reoperation. 

On Saturday, Jan. 24, from 10:15 to 10:25 a.m., Tomaz Mesar, MD, from the University of Pittsburgh Medical Center, will present An Age-Based Analysis of Transcatheter and Surgical Outcomes in Low-Risk Patients. The study compares outcomes of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in low-risk patients with aortic stenosis, with a particular focus on the impact of age on treatment outcomes.

Using a combined STS and TVT database, Dr. Mesar analyzed low-risk patients who underwent either SAVR or TAVR for degenerative aortic stenosis over a 13-year period, categorizing them into three age groups: under 65, 65-74, and over 75.

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As part of the “Updates in Structural Heart: Surgeons are Still in the Game” session, Dr. Mesar will present on the crucial role of age in determining the optimal approach—TAVR or SAVR—for structural heart interventions. His presentation will address how current findings suggest that TAVR may not be suitable for younger, low-risk patients due to observed higher mortality rates. 

For patients aged 65-74, the choice between TAVR and SAVR requires a personalized assessment, as neither procedure demonstrates a clear survival advantage. Finally, for patients over 75, while TAVR may offer a reduction in certain complications, SAVR appears to provide better long-term survival outcomes for this patient population.

In patients undergoing coronary artery bypass grafting (CABG), a novel analysis evaluating surgeon preference for multi- versus single-arterial grafting may help explain the differing results between prior retrospective analyses and randomized controlled trials regarding long-term survival.

A novel study to be presented on Friday, Jan. 24, at The Society of Thoracic Surgeons’ 61st Annual Meeting by lead author Justin Schaffer, MD, a cardiothoracic surgeon at Baylor Scott & White Health, offers fresh insights into the long-debated question of whether multi-arterial grafting (MAG) improves long-term survival compared to single-arterial grafting (SAG) in patients undergoing CABG. The analysis evaluates over one million Medicare beneficiaries and incorporates an innovative approach using surgeon preference as a tool to address unmeasured variables.

While the findings highlight nuances in interpreting retrospective and randomized trial data, they also underscore the need for future randomized studies, such as the forthcoming results of the ROMA trial, to definitively guide clinical decision-making.

The researchers emphasized that understanding the survival benefit of MAG over SAG requires randomized data, and it remains an important and open clinical question. 
 

In a landmark achievement for healthcare in Southeast Asia, St. Luke's Medical Center has launched the region's first robotic cardiac surgery program. This historic initiative was made possible through a collaborative effort between St. Luke's multidisciplinary team, led by Drs. Marvin Martinez and Ramiro Pablo, and the expert team from West Virginia University's (WVU) Heart and Vascular Institute, including Dr. Vinay Badhwar, Dr. Lawrence Wei, and physician assistant Herald Fe.

The program debuted with a series of innovative robotic-assisted cardiac procedures, showcasing the transformative potential of this advanced technology. Among the groundbreaking surgeries performed were:

• Robotic MIDCAB (Minimally Invasive Direct Coronary Artery Bypass)
• Robotic bileaflet mitral valve repair for severe mitral regurgitation (MR) due to bileaflet myxomatous disease
• Robotic mitral valve repair for endocarditis, including anterior mitral leaflet perforation
• Robotic adult congenital atrial septal reconstruction using a bovine patch for a patient with a common atrium
• Robotic aortic valve replacement (AVR) for a patient from Papua New Guinea

The first robotic valve surgery—a repair of a severely regurgitant mitral valve in a 40-year-old patient—marked a defining moment in the program's success. With guidance from WVU's Heart and Vascular Institute, the procedure was completed with precision and excellence, underscoring the collaboration's impact.

Dr. Pablo expressed his excitement, saying, "This is a monumental step forward for cardiac care in Southeast Asia. Our partnership with the WVU team has empowered us to provide patients with less invasive, highly precise procedures and faster recoveries."

Dr. Martinez added, "Establishing this robotic cardiac surgery program has been a dream realized through our team's dedication and the invaluable expertise of our WVU partners. This is just the beginning of a new era in cardiac care."

Reflecting on the collaboration, Dr. Badhwar remarked, "Teamwork truly makes the dream work. The exceptional multidisciplinary team at St. Luke's has shown that vision, determination, and collaboration can achieve extraordinary outcomes."

St. Luke's Robotic Cardiac Surgery Program is set to advance care across the region, offering minimally invasive options that reduce pain, recovery time, and the risk of complications.