Robotic Versus Sternotomy Approach for Left Atrial Myxoma Resection: A Retrospective Single-Center Study

<b>Objectives</b>: This study aimed to compare survival and outcomes between robotic-assisted and conventional sternotomy myxoma resection. <b>Methods</b>: This retrospective single-center study included 16 consecutive patients undergoing left atrial myxoma resection between April 2019 and June 2024. All procedures were performed by the same surgical team. The robotic approach involved peripheral cardiopulmonary bypass (CPB), Custodiol^® cardioplegia, and DaVinci Xi^® via right mini-thoracotomy. The primary endpoint was 30-day cerebrovascular accident-free survival. Secondary outcomes included 5-year survival, stroke, pacemaker implantation, bleeding, Intensive care unit, and hospital stay. <b>Results</b>: Sixteen patients were included (8 robotic, 8 sternotomy); median age was 58.0 [IQR 53.2-67.8] in the robotic group and 66.6 [62.0-71.0] years in the sternotomy group, with a similar sex distribution between groups. No significant baseline differences between groups except a lower EuroSCORE II in the robotic group (0.8% vs. 1.3%, <i>p</i> = 0.004). Robotic surgery resulted in significantly longer CPB time (181 vs. 46 min, <i>p</i> < 0.001) and cross-clamp time (67 vs. 31 min, <i>p</i> < 0.001), but similar intensive care unit stay (2.5 vs. 2.6 days, <i>p</i> = 0.95) and hospital stay (8.5 vs. 8.4 days, <i>p</i> = 0.87). At 30 days, stroke-free survival was 100% in both groups (<i>p</i> > 0.9). At 5 years, survival remained 100% in the robotic group versus 86% in the sternotomy group (<i>p</i> = 0.47). No conversions, reinterventions, or major postoperative complications were observed. <b>Conclusions</b>: Robotic-assisted resection of left atrial myxomas appears to be feasible and safe in a selected low-risk cohort, when compared with conventional sternotomy, with excellent mid-term survival despite longer operative times.