Robotic-assisted left atrial appendage occlusion: an important complementary option in the surgical management of atrial fibrillation

OBJECTIVES: The growing popularity of minimally invasive treatment of atrial fibrillation (AF) has shown increasing interest in concomitant left atrial appendage occlusion (LAAO). Surgical robotic technology adds advantages such as magnified visualization, enhanced dexterity of movement and decreased invasiveness. The aim of this study is to evaluate the effectiveness and early outcomes of robotic-assisted LAAO. METHODS: This is an observational, multicentre, retrospective study of patients with AF who underwent robotic-assisted LAAO. In-hospital mortality, perioperative complications, length of stay (LOS) and imaging-driven (cardiac CT scan, transesophageal echocardiography [TEE]) efficacy at 3-month follow-up were analysed. RESULTS: Between August 2019 and June 2024, 194 patients with documented AF (70.4% male, mean age 67.7 ± 10.1) underwent robotic-assisted epicardial LAAO. The procedure was performed under TEE guidance in 193 patients without complications. In one patient with previous sternotomy, LAAO was not feasible. Blood product transfusion was necessary in one patient, due to significant chest wall bleeding requiring thoracoscopic re-exploration. No stroke or thromboembolic events were observed. Left hemidiaphragm paralysis requiring plication occurred in 3 patients (1.5%). Hospital mortality was 0%. Mean LOS time was 2.2 days (range 1-10 days) and all patients were discharged home. Imaging follow-up was complete in 157 cases (81%) and was achieved by TEE in 91 patients while the remaining 66 underwent cardiac CT scan. Two patients had residual flow in the left atrial appendage and oral anticoagulant was continued at follow-up. CONCLUSIONS: Robotic-assisted LAAO is safe with satisfactory outcome both in an isolated setting and with concomitant hybrid ablating procedures for patients with AF.