Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
German Center of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
Heart Vessels. 2022 Oct;37(10):1669-1678. doi: 10.1007/s00380-022-02078-z. Epub 2022 Apr 29.
Robotic-assisted percutaneous coronary interventions (rPCI) have proven feasible and safe while reducing radiation exposure for the operator. Recently, rPCI systems have been refined to facilitate the treatment of complex lesions. The aim of the current study was to evaluate challenges and opportunities of establishing an rPCI program at a tertiary referral center. rPCI was performed using the CorPath GRX Vascular Robotic System (Corindus Inc., a Siemens Healthineers Company, Waltham, USA). Baseline, procedural, and in-hospital follow-up data were prospectively assessed. rPCI success was defined as completion of the PCI without or with partial manual assistance. The safety endpoint was the composite of missing angiographic success or procedure-related adverse events during hospital stay. Overall, 86 coronary lesions were treated in 71 patients (28.2% female) from January to April 2021. Median age was 71.0 years (IQR 60.3; 79.8). Indications for rPCI were stable angina pectoris (71.8%), unstable angina (12.7%) and non-ST elevation myocardial infarction (15.5%). Most lesions were complex (type B2/C: 88.4%) and included 7 cases of rPCI for chronic total occlusions. Angiographic and rPCI success were achieved in 100.0% and 94.2%, respectively. Partial manual assistance was used in 25.6%. Conversion to manual PCI was required in 5.8%. The safety endpoint occurred in 7.0% of patients. rPCI when applied as clinical routine for complex coronary lesions is effective with good immediate angiographic and clinical results. Future investigations should focus on the identification of patients that particularly benefit from robotic-assisted vs. manual PCI despite higher resource utilization.
机器人辅助经皮冠状动脉介入治疗（rPCI）已被证明是可行且安全的，同时减少了操作者的辐射暴露。最近，rPCI 系统得到了改进，以方便复杂病变的治疗。本研究旨在评估在三级转诊中心建立 rPCI 项目的挑战和机遇。rPCI 使用 CorPath GRX 血管机器人系统（Corindus Inc.，西门子健康公司，美国沃尔瑟姆）进行。前瞻性评估基线、手术和住院随访数据。rPCI 成功定义为 PCI 完成而无或有部分手动辅助。安全性终点是住院期间造影成功率缺失或与手术相关的不良事件的复合事件。总的来说，2021 年 1 月至 4 月，71 名患者（28.2%为女性）共治疗 86 处冠状动脉病变。中位年龄为 71.0 岁（IQR 60.3；79.8）。rPCI 的适应证为稳定型心绞痛（71.8%）、不稳定型心绞痛（12.7%）和非 ST 段抬高型心肌梗死（15.5%）。大多数病变为复杂病变（B2/C 型：88.4%），包括 7 例慢性完全闭塞的 rPCI。血管造影和 rPCI 成功率分别为 100.0%和 94.2%。部分手动辅助使用率为 25.6%。需要转换为手动 PCI 的比例为 5.8%。安全性终点发生率为 7.0%。当 rPCI 作为复杂冠状动脉病变的临床常规应用时，其效果良好，即刻血管造影和临床结果良好。未来的研究应重点关注识别那些尽管资源利用率较高，但特别受益于机器人辅助与手动 PCI 的患者。
