Robotic-Assisted Minimally Invasive Direct Coronary Artery Bypass Grafting with Concomitant Left Atrial Appendage Exclusion.

Off-pump robotic-assisted minimally invasive direct coronary artery bypass (MIDCAB) achieves revascularization without conventional sternotomy and provides benefit to patients that otherwise may not be ideal surgical candidates. For patients with comorbid atrial fibrillation, left atrial appendage exclusion may reduce stroke risk and is achievable via mini thoracotomy during concomitant MIDCAB. Here, we report four patients who underwent off-pump robotic-assisted MIDCAB and concurrent epicardial left atrial appendage exclusion. Intraoperative transesophageal echocardiography confirmed complete left atrial appendage exclusion in all cases. The concomitant robotic approach proved to be feasible, efficacious, and safe, with no postoperative mortality or stroke events during follow-up.