Wagener Max, Onuma Yoshinobu, Sharif Ruth, Coen Eileen, Wijns William, Sharif Faisal
College of Medicine, Nursing and Health Sciences, University of Galway, H91 TK33 Galway, Ireland.
Department of Cardiology, University Hospital Galway, Newcastle Road, H91 YR71 Galway, Ireland.
J Clin Med. 2024 Sep 19;13(18):5537. doi: 10.3390/jcm13185537.
Ischaemic heart disease is one of the major drivers of cardiovascular death in Europe. Since the first percutaneous coronary intervention (PCI) in 1977, developments and innovations in cardiology have made PCI the treatment of choice for stenotic coronary artery disease. To address the occupational hazards related to chronic exposure to radiation and wear and tear from heavy lead-based radioprotective aprons, the concept of robotically assisted PCI (R-PCI) was introduced in 2005. To explore the features and limitations of R-PCI, we first discuss the concept and evolution of R-PCI platforms and then systematically review the available clinical data. A systematic review has been performed across the Pubmed, Embase and Cochrane databases in order to assess the efficacy and safety of R-PCI. Secondary endpoints, such as operator and patient exposure to radiation, contrast volume used and procedural time, were assessed when available. In selected patients, R-PCI provides high technical and clinical success rates, ranging from 81 to 98.8% and from 93.3 to 100%, respectively. In-hospital and 1-year MACE rates ranged from 0 to 10.4% and 4.8 to 10.5%, respectively. R-PCI is able to significantly reduce the operator's exposure to radiation. Further research analysing the patient's and cath lab staff's exposure to radiation is needed. Therapy escalation with R-PCI seems to be limited to complex lesions. R-PCI procedures add approximately 10 min to the procedural time. The efficacy and safety of R-PCI have been proven, and R-PCI is able to significantly reduce occupational hazards for the first operator. The lack of adoption in the community of interventional cardiologists may be explained by the fact that current generations of R-PCI platforms are limited by their incompatibility with advanced interventional devices and techniques needed for escalation in complex interventions.
缺血性心脏病是欧洲心血管疾病死亡的主要驱动因素之一。自1977年首次进行经皮冠状动脉介入治疗（PCI）以来，心脏病学的发展和创新使PCI成为狭窄性冠状动脉疾病的首选治疗方法。为了解决与长期暴露于辐射以及厚重的铅制放射防护围裙造成的磨损相关的职业危害，2005年引入了机器人辅助PCI（R-PCI）的概念。为了探究R-PCI的特点和局限性，我们首先讨论R-PCI平台的概念和演变，然后系统地回顾现有的临床数据。我们在PubMed、Embase和Cochrane数据库中进行了系统综述，以评估R-PCI的疗效和安全性。如有可用数据，还评估了次要终点，如术者和患者的辐射暴露、造影剂用量和手术时间。在选定的患者中，R-PCI的技术成功率和临床成功率较高，分别为81%至98.8%和93.3%至100%。住院期间和1年的主要不良心血管事件（MACE）发生率分别为0%至10.4%和4.8%至10.5%。R-PCI能够显著减少术者的辐射暴露。需要进一步研究分析患者和心导管室工作人员的辐射暴露情况。R-PCI的治疗升级似乎仅限于复杂病变。R-PCI手术会使手术时间增加约10分钟。R-PCI的疗效和安全性已得到证实，并且R-PCI能够显著降低主刀医生的职业危害。目前一代的R-PCI平台因与复杂介入治疗升级所需的先进介入设备和技术不兼容而受到限制，这或许可以解释介入心脏病学界对其采用率较低的原因。
