Establishing a robotic-assisted PCI program: experiences at a large tertiary referral center

Abstract

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.

Robotic-assisted percutaneous coronary intervention: experience in Switzerland

“…Accordingly, 81% of the procedures were completed robotically with high clinical success and absence of in-hospital MACE (=robotic success). The rate of robotic success in our experiences was lower than that reported in other registries [robotic success of 91.7% in 108 patients in the CORA-PCI registry (6); 85.7% in 112 lesions reported by Lemos et al (13); or 94.2% in 84 lesions treated in Hamburg, Germany (14)], although the latter two reported robotic success based on lesion rather than procedure level and did not require absence of in-hospital MACE. To some extent, the lower robotic success rate in the present study may be attributable to a lower threshold for manual assistance or conversion to keep the procedure safe and avoid unnecessary delay to complete the intervention which is reflected in the high clinical success rate.…”

“…High rates of clinical success (>95%–100%) are consistently reported in most RA-PCI registries for first- ( 5 , 6 ) and second-generation robotic CorPath systems ( 7 , 13 ), across different lesion complexities ( 12 ). Two recent studies reported lower clinical success rates, due to higher rates (6.7%) of residual percent diameter stenosis in 30 RA-PCIs conducted in Japan ( 11 ) or higher rates of in-hospital MACE rates (7%) in 71 RA-PCIs (with a high proportion of complex lesions including CTOs) conducted in Germany ( 14 ).…”

Robotic percutaneous coronary intervention (R-PCI): Time to focus on the pros and cons

“… 15 (N-83) Seifert M et al, (2022). 16 (N-71) 1.Study end points – – – – – 2. Technical success 90.0%.…”

“… 15 (N-83) (L = 112) Seifert M et al, (2022). 16 (N-71) (L = 86) A 1.8% – – – 1.2% B2/C – – 47.9% – – B1 20.4% 36% – 22.3% 10.5% B2 16.7% 27% – 18.8% 18.6% C 61.1% 36% – 58.9% 69.8% Technical and Clinical success >90% >90% >90% >85% >90% …”

“… 15 (N-83) Seifert M et al, (2022). 16 (N-71) 1.Introducer needle (Gaining-arterial access) ∗ ∗ ∗ ∗ ∗ 2. Sheath introducer ∗ ∗ ∗ ∗ ∗ 3.Guide catheters ∗ – ∗ ∗ ∗ 4.Guidewire ∗∗ ∗∗ ∗∗ ∗∗ ∗∗ 5.Balloon catheter ∗∗ ∗∗ ∗∗ ∗∗ ∗∗ 6.Stents ∗∗ ∗∗ ∗∗ ∗∗ ∗∗ 7.Radioopaque dye delivery – – ∗∗ – ∗ (Note- ∗ - Manual and ∗∗ - Robot-assisted PCI).…”