Left Atrial Appendage Patch Exclusion With Injected Methylene Blue Confirmation During Robotic Mitral Surgery

Background Given the increasing use of robotic approaches in cardiac surgery, there remains considerable interest in developing easily reproducible techniques for left atrial appendage (LAA) exclusion through a robotic approach. The objective of the present study was to describe a simple, reproducible method for LAA patch exclusion at time of robotic mitral valve surgery. Methods Data were retrospectively collected for consecutive patients (n = 3) who underwent robotic mitral valve surgery using the described LAA exclusion technique between December 2025 and March 2026. Categorical variables are reported as counts and percentages, whereas continuous data are reported as medians and interquartile ranges. Results The median age was 67 [interquartile range, 65.5-73] years. All patients had a history of atrial fibrillation (AF). In all patients, postintervention transesophageal echocardiography demonstrated successful exclusion of the LAA, with no residual flow observed by color flow Doppler imaging. The median intensive care unit stay was 4 days (interquartile range, 3.5-4 days) and hospital duration was 8 days (interquartile range, 7-8 days). Each patient experienced a transient episode of AF in the postoperative period that was converted to sinus rhythm before hospital discharge. There were no other complications. Predischarge computed tomographic heart imaging showed an adequately excluded LAA in each case. There was no 30-day mortality. Conclusions Endocardial patch exclusion of the LAA with confirmatory methylene blue contrasted dye injection offers a simple and reproducible technique to confirm LAA exclusion in patients with AF who are undergoing robotic mitral valve surgery.