First-in-Human Totally Endoscopic Robotic Repair of Cor Triatriatum Sinistrum Under Ventricular Fibrillation.

BACKGROUND: Surgical correction of cor triatriatum sinistrum (CTS) has traditionally relied on conventional sternotomy with cardioplegic myocardial arrest. To date, there has been limited experience with totally endoscopic and robotic approaches, especially with ventricular fibrillation as an alternative to aortic cross-clamping and cardioplegic arrest. FIH: A 57-year-old man with dyspnea was found to have CTS without significant resting transmitral obstruction. Stress echocardiography and invasive hemodynamics revealed marked exercise-induced pulmonary hypertension. Given the abnormal stress physiology, surgical treatment through a totally endoscopic, robotic-assisted excision of the left intra-atrial membrane was performed using the Da Vinci Xi platform under controlled ventricular fibrillation induced by transvenous pacing. Complete resection was confirmed intraoperatively, and follow-up imaging demonstrated improved pulmonary pressures.

NOVELTY: This case demonstrates the feasibility of a totally endoscopic, robotic-assisted strategy for CTS treatment performed under ventricular fibrillation.

TAKE-HOME MESSAGE: Correction of CTS is feasible using a totally endoscopic and robotic-assisted approach.