Initial report of safety and procedure duration of robotic-assisted chronic total occlusion coronary intervention
Initial report of safety and procedure duration of robotic-assisted chronic total occlusion coronary intervention
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DOI：
10.1002/ccd.28477
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发表时间：
2020-01-01
影响因子：
2.3
通讯作者：
Salisbury, Adam C.
中科院分区：
文献类型：
--
作者：
Hirai, Taishi;Kearney, Kathleen;Salisbury, Adam C.
背景以前没有报告研究机器人辅助（RA）慢性完全闭塞（CTO）PCI与完全手动CTO PCI相比对手术持续时间或安全性的影响。方法95例CTO单病变PCI成功的患者中，49例（52%）行RA，46例（48%）完全手工操作。驾驶舱时间是指主操作员进入机器人驾驶舱直到程序完成的时间。对照组中的“理论”驾驶舱时间是主操作员在病变穿过后进入驾驶舱直到手术完成的时间。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、急性血栓形成和卒中。结果病变特征、手术时间和造影剂剂量相似。除1例（2%）选择在病变通过后由机器人完成外，所有手术均成功完成。两组间MAE的频率相似，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）。结论与完全手动CTO PCI相比，RA CTO PCI不会导致过多的不良事件，并且导致平均41 min的驾驶舱时间等于手术时间的48%，而没有辐射暴露或要求主要操作员穿戴铅围裙。了解驾驶舱时间与减少辐射暴露和操作员铅围裙相关骨科并发症之间的关系需要进一步研究。
Background 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. Methods 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. Results 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). Conclusion 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.