Hirai Taishi, Kearney Kathleen, Kataruka Akash, Gosch Kensey L, Brandt Hunter, Nicholson William J, Lombardi William L, Grantham J Aaron, Salisbury Adam C
Department of Medicine, Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri.
Department of Medicine, Division of Cardiology, University of Missouri Kansas City, Kansas City, Missouri.
Catheter Cardiovasc Interv. 2020 Jan;95(1):165-169. doi: 10.1002/ccd.28477. Epub 2019 Sep 4.
No previous reports have examined the impact of robotic-assisted (RA) chronic total occlusion (CTO) PCI on procedural duration or safety compared to totally manual CTO PCI.
Among 95 patients who underwent successful PCI of a single CTO lesion at two centers, 49 (52%) were performed RA and were performed 46 (48%) totally manually. Cockpit time was the time the primary operator entered to robotic cockpit until the procedure was complete. "Theoretical" cockpit time in the control group was time the primary operator would have entered the cockpit after lesion crossing until the procedure was complete. Major adverse events (MAEs) were the composite of death, myocardial infarction, clinical perforation, significant vessel dissection, arrhythmia, acute thrombosis, and stroke.
The lesion characteristics, procedural time, and contrast dose were similar. All procedures except for one (2%) selected for robotic completion after lesion crossing were completed successfully. The frequency of MAE was similar between groups and there were no in-hospital deaths. The cockpit time was 8 min longer in RA CTO PCI than the theoretical cockpit time in totally manual CTO PCI (40.6 ± 12.7 vs. 32.1 ± 17.8, p < .01).
RA CTO PCI was not associated with excess adverse events compared with totally manual CTO PCI and resulted in an average 41 min cockpit time equaling to 48% of procedure time without radiation exposure or requirement for the primary operator to wear a lead apron. Understanding the relationship between cockpit time and reductions in radiation exposure and lead apron-related orthopedic complications for operators requires future study.
与完全手动慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）相比，此前尚无关于机器人辅助（RA）CTO PCI对手术时长或安全性影响的报告。
在两个中心成功进行单处CTO病变PCI的95例患者中，49例（52%）接受了RA治疗，46例（48%）完全采用手动操作。驾驶舱时间是指主操作手进入机器人驾驶舱直至手术完成的时间。对照组的“理论”驾驶舱时间是指病变通过后主操作手进入驾驶舱直至手术完成的时间。主要不良事件（MAE）包括死亡、心肌梗死、临床穿孔、严重血管夹层、心律失常、急性血栓形成和中风。
病变特征、手术时间和造影剂用量相似。除1例（2%）病变通过后选择机器人完成手术外，所有手术均成功完成。两组间MAE发生率相似，且无院内死亡。RA CTO PCI的驾驶舱时间比完全手动CTO PCI的理论驾驶舱时间长8分钟（40.6±12.7 vs. 32.1±17.8，p<0.01）。
与完全手动CTO PCI相比，RA CTO PCI并未导致更多不良事件，平均驾驶舱时间为41分钟，占手术时间的48%，且无需辐射暴露或主操作手穿戴铅衣。了解驾驶舱时间与操作人员辐射暴露减少以及铅衣相关骨科并发症之间的关系需要未来进一步研究。
