A Totally Robot-Assisted Combined Aortic Valve and Ascending Aortic Replacement: Challenging the Sternotomy Paradigm.

PURPOSE: This study aims to introduce a robot-assisted Wheat procedure for the treatment of bicuspid aortic valve (BAV) complicated by ascending thoracic aortic aneurysm (ATAA) and severe aortic regurgitation, presenting it as a novel minimally invasive surgical option. DESCRIPTION: A 59-year-old male patient, diagnosed with an ATAA measuring 45.6 mm, bicuspid aortic valve, and severe aortic regurgitation, underwent a fully robot-assisted Wheat procedure. The pathological aortic valve was replaced with a 25-mm bioprosthesis, and the aneurysmal ascending aorta was excised and reconstructed using a 28-mm vascular graft. EVALUATION: The surgical procedure lasted 385 minutes, with a cardiopulmonary bypass (CPB) duration of 233 minutes and an aortic cross-clamp time of 175 minutes. The patient was extubated 16 hours postoperatively and discharged 9 days later, demonstrating excellent recovery, normal aortic valve function, and no perivalvular leakage. CONCLUSIONS: The robot-assisted Wheat procedure is technically feasible and safe for selected patients with ATAA and aortic valve disease. It offers a promising non-sternotomy approach; however, further experience is essential to broaden its indications to more complex cases.