Totally endoscopic aortic valve replacement, TAVI and the art of war

Abstract

‘The ultimate goal of warfare is to win without fighting’ Although, in its early years, cardiac surgery represented one of the most technologically advanced surgical specialties, inertia and lack of agency have struck the profession at its core. Contrary to other surgical specialties, such as general surgery, urology and gynaecology, which were keen to advance towards least-invasive operations, including laparoscopic and robotic procedures, cardiac surgeons have firmly resisted to partake in the hunt for the least-invasive approach to treat cardiac disease. Disheartening as it may be, cardiac surgeons have become notoriously slow to embrace innovation and adopt new techniques and technologies, therefore steadily disengaging from industry, which has directed its focus to catheter-based techniques. Alongside industry’s ample support, interventional cardiology has emerged as the patients' preference. In the span of a decade, transcatheter aortic valve implantation (TAVI) came to be the most disruptive cardiac intervention, rapidly altering the scene in the treatment of the aortic valve disease.