WVU Heart and Vascular Institute surgeons perform first robotic TAVR explant and aortic valve replacement

MORGANTOWN, W.Va. – In keeping with their commitment to advance cardiac care, the multidisciplinary team at the WVU Heart and Vascular Institute performed another world-first robotic heart surgery at the end of May, when they completed a robotic transcatheter aortic valve replacement (TAVR) explant and aortic valve replacement.

TAVR use to treat aortic stenosis, or a blocked aortic valve, has increased in recent years. Predominantly used for patients of increased age or surgical risk, the valve is implanted within a diseased native valve and performed via a catheter and without surgery. This has been an excellent option for some patients, but there has been rising concern for its use in younger, lower-risk patients due to durability. When these valves fail, this often requires open heart surgery.  

Thelma Hyer, 67, of Masontown underwent a TAVR procedure only four years ago at another hospital. At the time, she was told the replacement would last 10-15 years.

“TAVR is a superb treatment and one we support fully when used appropriately. This is ideal for patients who are at higher risk for surgery or of advanced age. However, based on the evidence, international guidelines recommend surgery for patients with aortic stenosis who are of younger age,” Vinay Badhwar, M.D., executive chair of the WVU Heart and Vascular Institute, said. 

“Unfortunately, when TAVR valves are implanted in patients who are under age 65 or 70 years, have a long life expectancy, and may be of lower risk, we are seeing a surge in patients across the country who are in need of having these valves explanted, largely due to premature failure.”

Hyer is among a growing group of TAVR patients who experience premature structural valve degeneration, which required removal and replacement of the valve. When she came to the WVU Heart and Vascular Institute, she presented with severe symptoms of premature blockage of her TAVR valve that also resulted in secondary problems, including a drop in her heart function and severe leakage of her mitral valve. 

Hyer also had severe symptoms of heart failure with shortness of breath, fatigue, and feeling faint or dizzy. She knew the valve needed to be replaced, but she was hoping to avoid a sternotomy, or incision through the front of her chest. 

She and her daughter, Jamie White, met Dr. Badhwar, who initially recommended open-heart surgery to remove the valve and replace both her failed valves. After listening to Hyer’s concerns given her history of scoliosis and arthritis, Badhwar proposed a procedure that had never been done before: a robotic TAVR explant (removal) and aortic valve replacement. The sternotomy would be the back-up plan. 

“He’s good at what he does, and his bedside manner is amazing,” White said. “He makes you, the patient, feel comfortable and at ease. He made sure she completely understood that her safety and healing were his first and foremost objective.”

The team – comprised of Badhwar; cardiac surgeons Ali Darehzereshki, M.D., Goya Raikar, M.D., J. Hunter Mehaffey, M.D., and Lawrence Wei, M.D.; and cardiologist Ramesh Daggubati, M.D. – took Hyer to the operating room on the morning of May 27 for robotic TAVR explant and planned replacement of both her aortic and mitral valves, and by that afternoon, she was recovering in the Cardiovascular Intensive Care Unit. Less than a week later, she was discharged home.

“I’m so thankful I found him, and that I chose to trust the WVU team,” Hyer said of Badhwar and the advanced team of the WVU Heart and Vascular Institute. “Other people all over the world with my problem of a failed valve may have this opportunity as well.”

The robotic aortic valve replacement (RAVR) procedure was developed at the WVU Heart and Vascular Institute in 2020 and is now performed in multiple institutions around the world. It comes on the heels of the Heart and Vascular Institute’s several innovations and “firsts” associated with robotic heart surgery, including completion of the first-ever combined valve replacement and coronary artery bypass in October 2024. 

“We are focused on providing comprehensive solutions to complex problems in the least invasive manner possible. It has been an honor to be part of the wonderful multidisciplinary team at the WVU Heart and Vascular Institute who share and support this vision,” Badhwar said. 

“It is a privilege to help evolve the field of robotic heart surgery by innovating techniques and teaching other colleagues around the world. However, there is no greater reward than seeing the benefit of these efforts in the lives of the patients we are humbled to serve.”

For more information on the WVU Heart and Vascular Institute, visit WVUMedicine.org/Heart.