Robotic Left Atrial Appendage Occlusion: Insights From Real-World Practice

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Procedures
• Medical Device Technology

Background:

• Atrial fibrillation increases stroke risk, often necessitating anticoagulation.
• Left atrial appendage occlusion (LAAO) is an alternative stroke prevention strategy.
• Robotic assistance may enhance procedural precision and safety.

Purpose of the Study:

• To report initial outcomes of robotic-assisted LAAO device deployment.
• To evaluate the safety and efficacy of this novel approach.

Main Methods:

• Prospective enrollment of consecutive patients undergoing robotic LAAO from June 2021 to December 2024.
• Inclusion of patients undergoing isolated LAAO or combined with robotic-assisted coronary artery bypass grafting (CABG).
• Use of an epicardial clip for LAAO device deployment.

Main Results:

• 28 patients included; 22 had concomitant CABG.
• Excellent LA appendage exclusion confirmed in 96.4% via transesophageal echocardiogram.
• No perioperative strokes, myocardial infarctions, bleeding reoperations, or deaths.
• At median 1.4 years follow-up, 1 non-cardiac mortality and 1 stroke occurred.
• 32.1% of patients discontinued oral anticoagulation (OAC).

Conclusions:

• Robotic LAAO demonstrates optimal stroke prevention in a high-risk cohort.
• The procedure shows a favorable safety profile with encouraging early results.
• Longer follow-up is necessary to validate these findings.