Perioperative management and postoperative complications after robotic-assisted convergent procedure for persistent atrial fibrillation: A case series

The Convergent Procedure for the treatment of persistent atrial fibrillation has been in use since 2009. This procedure combines epicardial ablation, performed via video-assisted thoracoscopic surgery and the surgical clipping of the left atrial appendage. The robotic approach is a relatively novel procedure, involving an entirely thoracoscopic approach for both procedures. Here we present our experience of a cohort of 11 patients at our institution who underwent a robotic-assisted convergent procedure. We discuss the anesthetic considerations of the surgery, including pain management, hemodynamic derangement, echocardiographic guidance, ventilation strategies, and fluid management. Postoperative complications, especially a high incidence of pulmonary complications necessitating a longer hospital length of stay compared to the traditional convergent procedures, are described. We discuss possible causes and strategies to mitigate these problems in future cases. A robust understanding of these potential complications emphasizes the importance of meticulous perioperative management during this procedure.