Safety and feasibility of robotic assisted percutaneous coronary intervention compared to standard percutaneous coronary intervention- a systematic review and meta-analysis

Abstract

Objective Robotically assisted PCI offers a great alternative to S–PCI. This has gained even more relevance during the COVID-19 pandemic era however safety of R–PCI compared to S–PCI has not been studied well. This study explores the safety and efficacy of robotically assisted PCI (R–PCI) compared to standard PCI (S–PCI) for the treatment of coronary artery disease (CAD). Methods PubMed, Scopus, Ovid, and Google scholar databases were searched for studies comparing R–PCI to S–PCI. Outcomes included clinical success, procedure time, fluoroscopy time, contrast use and radiation exposure. Results Theauthors included 5 studies comprising 1555 patients in this meta-analysis. Clinical success was comparable in both arms (p = 0.91). Procedure time was significantly longer in R–PCI group (risk ratio: 5.52, 95% confidence interval: 1.85 to 9.91, p = 0.003). Compared to S–PCI, patients in R–PCI group had lower contrast use (meandifference: −19.88, 95% confidence interval: −21.43 to −18.33, p < 0.001), fluoroscopy time (mean difference:-1.82, 95% confidence interval: −3.64 to −0.00, p = 0.05) and radiation exposure (mean difference:-457.8, 95% confidence interval: −707.14 to −208.14, p < 0.001). Conclusion R–PCI can achieve similar success as S–PCI at the expense of longer procedural times. However, radiation exposure and contrast exposure were lower in the R–PCI arm.

Robotic Percutaneous Coronary Intervention in Coronary Heart Disease: Applications and Recent Advances

“…Moreover, several experiments have indicated that the procedure time of R-PCI is significantly longer than that of T-PCI (R-PCI vs. T-PCI: 42:59 ± 26:14 min vs 34:01 ± 17:14 min, P = 0.007) [22]. Similar results have been reported in a study by Tripathi et al [23], in which the procedure time of R-PCI was significantly longer than that of T-PCI, with a risk ratio of 5.52 (95% CI:1.85-9.91, P = 0.003).…”

“…In addition, some case reports with complex coronary lesions treated with R-PCI provided further support for this conclusion [20,21]. A recent meta-analysis including 1535 patients (552 receiving R-PCI and 983 receiving T-PCI) has shown comparable clinical success between R-PCI and T-PCI, and has indicated that R-PCI requires less contrast use than T-PCI [23].…”

Digital variance angiography in patients undergoing lower limb arterial recanalization: cost–effectiveness analysis within the English healthcare setting

“…The following information was used in the calculation of the per procedure additional cost associated with use of DVA: hardware, monitor and installation costs, device lifespan, procedure time, preparation time, availability of catheterization laboratory per year (hourly) and associated costs, including overheads, as well as the annual maintenance and warranty costs associated with the DVA device. This information was used to calculate a per procedure average cost associated with DVA (£10.19; SD = 1.91, min = 6.41, max = 18.16), which considered the overall cost of DVA and related resources, as well as the maximum number of angiography procedures that would be performed per year (estimated at 4147, considering the available cath lab h per year [ 43 , 44 ], as well as the angiography preparation and procedure time [ 42 ]). Therefore, in the intervention arm, use of DVA alongside current practice imaging was assumed to be acceptable in 100% of cases.…”

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

“… 7 Byomesh Tripathi r et al (2021) defined separate endpoints for safety, including contrast use, fluoroscopy time, and radiation exposure. 8 ( Table 1 , Table 2 ).…”