Robotic transmitral resection of floating left ventricular thrombus

Despite the role of surgery in the management of left ventricular (LV) thrombi remaining controversial, robotic LV thrombectomy has emerged as a viable treatment option. This study aimed to present our successful experience with a robotic mitral program, detailing the operative technique. We conducted a retrospective analysis of our institutional database to identify patients who underwent LV thrombectomy using the da Vinci robot system. Subsequently, serial echocardiograms and short- and long-term outcomes were reviewed and analyzed using descriptive statistics. Five patients (median age: 46 years) were included in this study. All patients presented with a floating LV thrombus and a history of embolization. Among them, four patients experienced reduced heart function, none had coronary artery disease, three experienced dilated cardiomyopathy. Complete resection was achieved in all cases, with no postoperative deaths, strokes, or major complications. In addition, LV function showed improvement during follow-up periods. Postoperative anticoagulation was continued for 2 years in one patient and 1 year in the remaining patients. No recurrence or further embolic events were observed during the median follow-up period of 6 years. Robotic LV thrombectomy yields excellent outcomes and should be considered early for patients with floating LV thrombi. However, further investigation is warranted to determine the optimal timing of this intervention and its role in the treatment paradigm, including whether these results can be extrapolated to patients with other forms of mobile thrombus and/or to support surgery as the primary prevention of systemic embolization.