Robotic Left Atrial Myxoma Resection: Feasibility and Early Outcomes from a Single-Center Experience

BACKGROUND Robotic resection of left atrial myxomas has emerged as a minimally invasive alternative to sternotomy, but comparative data is limited. We evaluated referral patterns and outcomes following robotic left atrial myxoma at a high-volume robotic cardiac surgery center. METHODS We identified 42 consecutive adults undergoing isolated left atrial myxoma resection between 2011 to 2024 from a prospective institutional registry. Outcomes were compared by operative approach. Our primary outcome was the Society of Thoracic Surgeons risk-adjusted composite morbidity and mortality at 30-days. Our secondary outcome was tumor recurrence. Median follow-up was 2 years (IQR: 0.1-4 years). RESULTS Of 42 patients undergoing surgical myxoma resection, 16 (38%) received sternotomy and 26 (62%) received robotic resection. Myxomas were identified following incidental imaging (n=22, 52%) or symptomatic disease (n=20, 48%). Baseline characteristics between patients undergoing open and robotic tumor resection were similar (67 vs 63 years, p=0.59; female 15% vs 21%, p=0.38; LVEF 63% vs 63%, p=0.84), as were tumor size and cardiopulmonary bypass time.Robotic resection was associated with shorter operative time (161 vs 188 minutes, p=0.007), while sternotomy was associated with greater product transfusion (38% vs 8%, p=0.04) and atrial septal defect repair (63% vs 27%, p=0.02). Composite morbidity and mortality did not differ by approach (7.7% open vs 6.3% robotic, p=1.0). There were no deaths or strokes at 30-days, and no recurrences at 2 years. CONCLUSIONS Robotic left atrial myxoma resection is feasible at an experienced center without compromising short-term outcomes. Longer imaging follow-up is required to assess comparative durability.