Early outcomes of a formal robotic congenital cardiac surgery program

Background: Robotic cardiac surgery for congenital disease has been limited mainly to adult patients.Here we describe cardiac repairs in pediatric and adult patients with a variety of congenital lesions performed in a robotic cardiac surgery program. Methods: All patients undergoing robotic repair of congenital anomalies at the Children's Hospital of New York and Milstein Hospital between November 2023 and April 2025 were included.Cardiopulmonary bypass was achieved using open or percutaneous femoral arterial and venous access, along with jugular venous access.Results: Twenty-six patients were identified, including 11 pediatric patients (range, age 6-19 years) and 15 adults (range, 22-63 years).The most frequent indications were secundum atrial septal defect (n = 14; 53.8%) and partial anomalous pulmonary venous return (n = 7; 26.9%), including sinus venosus atrial septal defect (n = 4; 15.4%) and scimitar syndrome (n = 3; 11.5%).The median patient age and weight were 27.0 years (interquartile range [IQR], 12.3-39.5years) and 65.7 kg (IQR: 53.2-76.7 kg).The median length of stay was 4 days (IQR, 3-4.8 days).Aortic cross-clamping was achieved using a transthoracic clamp (n = 10) or endoaortic balloon (n = 15).No death, conversion to sternotomy, or reoperation occurred.Three cases of pleural effusion and 2 cases of pericarditis occurred.Conclusions: Robotic surgery is a safe and efficacious strategy for repairing selected congenital heart lesions across the lifespan.Adoption of robotic surgery in congenital heart disease likely will expand as comfort with the technology evolves.(JTCVS Open 2026;:101564) Isolation of the scimitar vein before direct anastomosis to the left atrium.Adapted from Blitzer and colleagues. 1 CENTRAL MESSAGE Robotic surgery is a safe and efficacious treatment for selected congenital cardiac lesions in pediatric and adult patients. PERSPECTIVERobotic open-heart surgery is a safe and efficacious approach to treating congenital cardiac lesions, such as ASD, PAPVR, scimitar syndrome, VSD, and mitral and tricuspid valve diseases in patients as young as 6 years and as small as 37.5 kg.This minimally invasive approach may become increasingly common as training in robotic cardiac surgery expands within the congenital community. See Commentary on page XXX.Robotic surgery has emerged as a viable option for selected patients undergoing cardiac surgery.Compared with traditional open-heart surgery, robotic approaches provide many advantages, including cosmetic benefits, reduced risk of infection, less perioperative blood loss, less postoperative pain, and shorter postoperative length of stay. [2][3]3][4][5][6] Robotic surgery also has expanded to repair congenital heart defects (CHDs), such as atrial septal defect (ASD), 7-9 ventricular From the a Section of Congenital and Pediatric Cardiac Surgery, Division of Cardiac,