Cardiology Plus最新文献_第2页

The Effect of Frailty on Independent Living After Surgery: A Population-Based Retrospective Cohort Study. 虚弱对术后独立生活的影响：基于人群的回顾性队列研究

IF 3.9 Q4 Medicine

Cardiology Plus

Pub Date : 2024-01-01 DOI: 10.14283/jfa.2023.27

A Garland, T Mutter, O Ekuma, C Papadimitropolous

Background: Most people value quality of life over mere duration. At least 50% of people are extremely averse to ever living in a nursing home (NH).

Objectives: Assess whether pre-operative frailty is associated with new, post-operative NH placement.

Design, setting: Retrospective, population-based cohort study in the Canadian province of Manitoba, 2000-2017.

Participants: 7408 persons ≥65 years undergoing any of 16 specific, elective, noncardiac surgeries of varying Operative Surgical Stress (OSS).

Measurements: The primary outcome was new admission to a NH, or being placed on a waiting list for a NH, within 180 days of index hospital admission, among index hospital survivors. Frailty was assessed from administrative data by the Preoperative Frailty Index (pFI), which ranges 0-1. Other outcomes were 30-day and 90-180 day mortality, and post-hospital medical resource use to 180 days. Analyses used multivariable regression models, adjusted for age, sex, OSS, year of surgery, anesthetic technique, and socioeconomic status. P-values were adjusted for the six outcomes.

Results: Subjects had mean age (±SD) of 74±7 yrs; 61% were male. pFI ranged 0-0.68, with a mean±SD of 0.21±0.09. All six outcomes were significantly associated with greater frailty. Each additional 0.1 unit increase in pFI was associated with a hazard ratio for new NH admission or wait-listing of 3.01 (p<0.0006).

Conclusions: While our study agrees with prior work indicating that greater frailty is associated with higher probability of post-operative discharge to a NH, it overcomes a number of limitations of all prior work. Strong arguments follow that prospective surgical candidates be evaluated for their degree of frailty, and that their informed consent include discussion of the possibility of survival with loss of independence.

背景：大多数人重视生活质量，而不是单纯的时间长短。至少有 50%的人极不愿意住进养老院（NH）：评估术前体弱是否与术后新的养老院安置有关：2000-2017年在加拿大马尼托巴省进行的基于人口的回顾性队列研究：7408名年龄≥65岁的患者接受了16种不同手术压力（OSS）的特定择期非心脏手术中的任何一种：主要结果是指数医院幸存者在指数医院入院后 180 天内再次入住 NH 或被列入 NH 等候名单。根据管理数据，用术前虚弱指数（pFI）对虚弱程度进行评估，该指数范围为 0-1。其他结果包括 30 天和 90-180 天死亡率，以及住院后 180 天的医疗资源使用情况。分析采用多变量回归模型，并对年龄、性别、OSS、手术年份、麻醉技术和社会经济状况进行了调整。对六项结果的P值进行了调整：受试者的平均年龄（±SD）为 74±7 岁；61% 为男性。PFI 为 0-0.68，平均值（±SD）为 0.21±0.09。所有六种结果都与体弱程度明显相关。pFI 每增加 0.1 个单位，新入住 NH 或等待入院的危险比为 3.01（p 结论：虽然我们的研究与之前的研究结果一致，都表明体弱程度越高，术后出院到 NH 的概率就越高，但我们的研究克服了之前所有研究的一些局限性。因此，我们有充分的理由认为，应该对潜在的手术候选者进行体弱程度评估，并在他们的知情同意书中讨论在失去独立性的情况下生存的可能性。

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引用次数: 0

Acute myocardial infarction in a patient with thrombotic thrombocytopenic purpura: a case report and literature review 一名血栓性血小板减少性紫癜患者的急性心肌梗死：病例报告和文献综述

Q4 Medicine

Cardiology Plus

Pub Date : 2023-12-12 DOI: 10.1097/cp9.0000000000000068

Feng Hu, Mengjia Chen, Xun Yuan, Yunling Lin, Lianglong Chen

Acute myocardial infarction (AMI) induced by thrombotic thrombocytopenic purpura (TTP) has been previously reported, but comorbidity with autoimmune hemolytic anemia is rare. The index patient, a 55-year-old woman, presented with acute ST-elevation myocardial infarction (STEMI). A diagnosis of TTP was established on the presence of thrombocytopenia, microangiopathic hemolytic anemia, acute kidney injury, fever, and neurologic symptoms (ischemic stroke); autoimmune hemolytic anemia was established based on Comboost test. Percutaneous coronary intervention and dual antiplatelet therapy were not initiated due to elevated risk of bleeding. Instead, the patient was treated with glucocorticosteroid and plasmapheresis. Despite the treatment, the patient suffered a watershed acute cerebral infarction, and finally died of gastrointestinal bleeding. This case highlights the challenges in managing STEMI in TTP patients.

血栓性血小板减少性紫癜（TTP）诱发急性心肌梗死（AMI）的病例已有报道，但合并自身免疫性溶血性贫血的病例并不多见。该例患者是一名 55 岁的女性，出现急性 ST 段抬高型心肌梗死（STEMI）。根据血小板减少、微血管病性溶血性贫血、急性肾损伤、发热和神经系统症状（缺血性中风）确诊为 TTP；根据 Comboost 试验确诊为自身免疫性溶血性贫血。由于出血风险升高，患者没有接受经皮冠状动脉介入治疗和双联抗血小板治疗。相反，患者接受了糖皮质激素和血浆置换治疗。尽管进行了治疗，患者还是发生了分水岭急性脑梗死，最后死于消化道出血。该病例凸显了治疗 TTP 患者 STEMI 所面临的挑战。

引用次数: 0

Non-alcoholic fatty liver disease and risk of cardiovascular diseases: clinical association, pathophysiological mechanisms, and management 非酒精性脂肪肝与心血管疾病风险：临床关联、病理生理机制与管理

Q4 Medicine

Cardiology Plus

Pub Date : 2023-12-08 DOI: 10.1097/cp9.0000000000000067

Rong Yang, Jian-Gao Fan

Non-alcoholic fatty liver disease (NAFLD) is a fatty liver disease associated with metabolic dysfunction in genetically susceptible individuals due to over-nutrition and lack of exercise. With the prevalence of obesity, metabolic syndrome, and type 2 diabetes mellitus, NAFLD has become the most common cause of chronic liver disease worldwide. NAFLD shares many risk factors with cardiovascular diseases (CVDs). NAFLD is associated with increased risk of major cardiovascular events and other cardiac complications even after adjustment for traditional cardiovascular risk factors. The primary pathology of NAFLD is within the liver, but the most common cause of deaths in patients with NAFLD is CVDs. This review summarizes the epidemiological evidence for the association between NAFLD and CVD risk and the pathophysiological mechanisms underlying this association. Current treatment strategies for NAFLD and their potential impact on CVD risk are also discussed.

非酒精性脂肪肝（NAFLD）是一种脂肪肝，与遗传易感人群因营养过剩和缺乏运动导致的代谢功能障碍有关。随着肥胖、代谢综合征和 2 型糖尿病的流行，非酒精性脂肪肝已成为全球最常见的慢性肝病。非酒精性脂肪肝与心血管疾病（CVDs）有许多共同的风险因素。即使在调整了传统的心血管风险因素后，非酒精性脂肪肝仍与重大心血管事件和其他心脏并发症的风险增加有关。非酒精性脂肪肝的主要病理变化在肝脏，但非酒精性脂肪肝患者最常见的死因是心血管疾病。本综述总结了非酒精性脂肪肝与心血管疾病风险之间关联的流行病学证据，以及这种关联的病理生理机制。此外，还讨论了非酒精性脂肪肝的当前治疗策略及其对心血管疾病风险的潜在影响。

引用次数: 0

Characteristics of patients undergoing percutaneous coronary intervention for chronically total occluded arteries: a single-center observational study in India 慢性全动脉闭塞患者经皮冠状动脉介入治疗的特点:印度的一项单中心观察性研究

Q4 Medicine

Cardiology Plus

Pub Date : 2023-10-05 DOI: 10.1097/cp9.0000000000000061

Abhijit Khadtare, Chandrashekhar Makhale, Shrish Hiremath, Purvez Grant

Background and purpose: Percutaneous coronary intervention (PCI) is the gold standard for managing chronic total occlusion (CTO), but data on characteristics of the patients undergoing PCI for CTO are scarce. The present study was designed to evaluate the clinical profile of the patients who underwent PCI to CTO. Methods: This single-center, prospective, and observational study included consecutive patients who successfully underwent PCI for angiographically confirmed CTO at author’s center from March 2017 to March 2019. Follow-up was conducted at 6 and 12 months. Results: The final analysis included a total of 108 patients. The mean age was 64.5 ± 8.2 years. Majority of the patients (72.2%) were men. The most common morbid risk factors were diabetes mellitus (56.5%), hypertension (53.7%), and dyslipidemia (52.8%). Mean left ventricular ejection fraction (LVEF) was 51% ± 0.0% and 73% had New York Heart Association (NYHA) class II. The most common site of CTO was the right coronary artery (34.3%). PCI was conducted using an antegrade approach, 75.9% of the cases. The majority of patients underwent wire escalation PCI technique (52.8%) followed by adverse drug reaction (34.3%), reverse-controlled antegrade and retrograde tracking (CART) (8.3%) and CART (4.6%). Stress test was negative in 63% and 64.8% of the patients at 6 and 12 months, respectively. The 6-month symptom-free survival rate was higher in patients without hypertension. Symptom-free survival rate was 96.9%, 95.9% and 88.9% in patients with Japanese Multicenter CTO Registry (J-CTO) score of 0, 1 and >3, respectively. The rate of abnormal electrocardiogram at 12 months was higher in patients with J-CTO score of 0 or 1 versus >3. Conclusion: PCI is a viable option for patients who are not willing to undergo coronary artery bypass grafting, particularly in those with low J-CTO score.

背景和目的:经皮冠状动脉介入治疗(PCI)是治疗慢性全闭塞(CTO)的金标准，但关于接受PCI治疗CTO患者特征的数据很少。本研究旨在评估PCI - CTO患者的临床表现。方法:这项单中心、前瞻性和观察性研究纳入了2017年3月至2019年3月在作者中心成功接受血管造影证实的CTO PCI治疗的连续患者。随访时间分别为6个月和12个月。结果:最终分析共纳入108例患者。平均年龄64.5±8.2岁。男性占多数(72.2%)。最常见的发病危险因素为糖尿病(56.5%)、高血压(53.7%)和血脂异常(52.8%)。平均左室射血分数(LVEF)为51%±0.0%，73%为纽约心脏协会(NYHA) II级。CTO最常见部位为右冠状动脉(34.3%)。采用顺行入路行PCI，占75.9%。采用线段升高PCI技术的患者最多(52.8%)，其次为药物不良反应(34.3%)、反向控制顺行和逆行追踪(CART)(8.3%)和CART(4.6%)。6个月和12个月压力测试分别有63%和64.8%的患者呈阴性。无高血压患者6个月无症状生存率较高。日本多中心CTO Registry (J-CTO)评分为0分、1分和3分的患者无症状生存率分别为96.9%、95.9%和88.9%。J-CTO评分为0或1的患者12个月心电图异常率高于评分为3的患者。结论:对于不愿意接受冠状动脉旁路移植术的患者，特别是J-CTO评分较低的患者，PCI是一种可行的选择。

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引用次数: 0

Contribution of cardiovascular disease to the burden of non-communicable diseases in Africa: an analysis of data from Global Burden of Disease database, 1990–2019 心血管疾病对非洲非传染性疾病负担的贡献:对1990-2019年全球疾病负担数据库数据的分析

Q4 Medicine

Cardiology Plus

Pub Date : 2023-07-25 DOI: 10.1097/cp9.0000000000000057

M. Maimaitiming, A. Kakunze, Yikai Feng, Minmin Wang, Na Li, Junyi Shi, Kepei Huang, Yinzi Jin, Zhijie Zheng

Disease burden of non-communicable diseases (NCDs) has been increasing in low- and middle-income countries, especially in African countries. Cardiovascular disease (CVD) is a common NCDs and the leading cause of death in Africa. Yet, evidence on the contribution of CVD to the total NCDs burden is scarce. This study aimed to investigate the contribution of CVD to the total disease burden caused by NCDs in Africa between 1990 and 2019. Data on NCDs, including CVD, were extracted from the Global Burden of Disease (GBD) database. Disease burden was measured by disability-adjusted life years (DALYs) and deaths. From 1990 to 2019, the share of CVD in the total NCDs burden increased and remained as the first contributor. In 2019, NCDs caused 204 million DALYs and over 2.18 million deaths in the Africa Union, among which 49.1% of the total DALYs and 66.0% of deaths were caused by the traditional five NCDs, including CVD that accounted for the largest burden of NCDs (20.5% of DALYs and 35.2% of deaths). The proportion of CVD to the total NCDs burden was most considerable, reaching up to 32.4% and 52.4% in Northern Africa for DALYs and deaths, respectively. CVD were important contributors to NCDs burden in Africa, including ischemic heart disease (1334 DALYs per 100,000 and 27.79 deaths per 100,000) and intracerebral hemorrhage (632 DALYs per 100,000 and 13.53 deaths per 100,000) that were the top two causes of NCDs in 2019. CVD has been the biggest contributor to NCDs burden in the Africa Union over the thirty years. Given the increase in the share of NCDs burden attributable to CVD, it demands a close attention to implementing cost-effective policies and interventions for CVD to achieve an improvement in population health and reduction of health loss from NCDs.

在中低收入国家，特别是非洲国家，非传染性疾病的疾病负担一直在增加。心血管疾病（CVD）是非洲常见的非传染性疾病，也是导致死亡的主要原因。然而，关于心血管疾病对非传染性疾病总负担的贡献的证据很少。这项研究旨在调查1990年至2019年间CVD对非洲非传染性疾病造成的总疾病负担的贡献。包括心血管疾病在内的非传染性疾病数据取自全球疾病负担数据库。疾病负担是通过残疾调整生命年（DALYs）和死亡来衡量的。从1990年到2019年，心血管疾病在非传染性疾病总负担中的份额增加，并一直是第一贡献者。2019年，非传染性疾病在非洲联盟造成2.04亿DALY和218多万人死亡，其中49.1%的DALY总数和66.0%的死亡是由传统的五种非传染性疾病引起的，包括心血管疾病，它是非传染性疾病的最大负担（20.5%的DALY和35.2%的死亡）。心血管疾病在非传染性疾病总负担中的比例最为可观，在北非，DALY和死亡人数分别高达32.4%和52.4%。CVD是非洲非传染性疾病负担的重要因素，包括缺血性心脏病（每100000人中有1334人DALY，每100000人死亡27.79人）和脑出血（每100000万人中有632人DALY和每100000人有13.53人死亡），这是2019年非传染性疾病的前两大原因。心血管疾病是非洲联盟30年来非传染性疾病负担的最大贡献者。鉴于心血管疾病在非传染性疾病负担中所占份额的增加，需要密切关注实施具有成本效益的心血管疾病政策和干预措施，以改善人口健康，减少非传染性疾病造成的健康损失。

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引用次数: 0

A transcatheter “sandwich” valve-in-valve implantation for pure aortic regurgitation: a report of 2 cases 经导管“夹层”瓣内植入治疗单纯主动脉反流2例报告

Q4 Medicine

Cardiology Plus

Pub Date : 2023-07-01 DOI: 10.1097/cp9.0000000000000059

Shasha Chen, Dawei Lin, Yiming Qi, Daxin Zhou, Wenzhi Pan, Junbo Ge

The application of transcatheter aortic valve replacement (TAVR) for severe pure native aortic valve regurgitation (PNAR) remains limited. TAVR for PNAR using an off-label device is associated with acceptable procedural success but increased early mortality. For performing TAVR for PNAR patients, appropriate anatomy, especially a relatively small aortic annulus, is a necessary condition for successful procedure, and large aortic annulus is generally excluded. Here, we report using a new transcatheter “sandwich” valve-in-valve implantation technique with commercially available devices for treating two cases of PNAR, including one with a extremely large aortic annulus (namely aortic annulus perimeter over 91.1 mm, respectively, according to the industry instructions VitaFlow®). The conditions of both patients improved, and there were no complications during the follow-up periods. The new transcatheter “sandwich” valve-in-valve implantation technique using the commercially available self-expanding devices could be an option for treating PNAR patients with an extremely large annulus at high risk for surgery. This technique can also be an effective remedy for the first valve to be placed too high and jump up to the ascending aorta.

经导管主动脉瓣置换术(TAVR)在重度纯原生主动脉瓣返流(PNAR)中的应用仍然有限。使用标签外装置治疗PNAR的TAVR与可接受的手术成功相关，但增加了早期死亡率。对于PNAR患者进行TAVR，适当的解剖结构，特别是相对较小的主动脉环，是手术成功的必要条件，大的主动脉环通常被排除在外。在这里，我们报告使用一种新的经导管“三明治”瓣膜植入技术和市上可用的设备治疗两例PNAR，其中一例主动脉环非常大(即主动脉环周长分别超过91.1 mm，根据行业说明VitaFlow®)。两例患者病情均有改善，随访期间无并发症发生。新的经导管“三明治”瓣膜植入技术使用市售的自膨胀装置，可能是治疗具有极大环隙且手术风险高的PNAR患者的一种选择。这项技术也可以有效地治疗第一个瓣膜放置得太高而跳到升主动脉的情况。

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引用次数: 0

Injury mechanism of COVID-19-induced cardiac complications. 新型冠状病毒感染心脏并发症的损伤机制

Q4 Medicine

Cardiology Plus

Pub Date : 2023-07-01 Epub Date: 2023-06-23 DOI: 10.1097/CP9.0000000000000055

Ling Leng, Xiu-Wu Bian

Heart dysfunction is one of the most life-threatening organ dysfunctions caused by coronavirus disease 2019 (COVID-19). Myocardial or cardiovascular damage is the most common extrapulmonary organ complication in critically ill patients. Understanding the pathogenesis and pathological characteristics of myocardial and vascular injury is important for improving clinical diagnosis and treatment approach. Herein, the mechanism of direct damage caused by severe acute respiratory syndrome coronavirus 2 to the heart and secondary damage caused by virus-driven inflammation was reviewed. The pathological mechanism of ischemia and hypoxia due to microthrombosis and inflammatory injury as well as the injury mechanism of tissue inflammation and single myocardial cell necrosis triggered by the viral infection of pericytes or macrophages, hypoxia, and energy metabolism disorders were described. The latter can provide a novel diagnosis, treatment, and investigation strategy for heart dysfunctions caused by COVID-19 or the Omicron variant.

心脏功能障碍是2019冠状病毒病（新冠肺炎）引起的最危及生命的器官功能障碍之一。心肌或心血管损伤是危重患者最常见的肺外器官并发症。了解心肌和血管损伤的发病机制和病理特征对于改进临床诊断和治疗方法具有重要意义。本文综述了严重急性呼吸综合征冠状病毒2型对心脏的直接损伤和病毒驱动的炎症引起的继发性损伤的机制。介绍了微血栓和炎症损伤引起的缺血缺氧的病理机制，以及由周细胞或巨噬细胞的病毒感染、缺氧和能量代谢紊乱引发的组织炎症和单个心肌细胞坏死的损伤机制。后者可以为新冠肺炎或奥密克戎变异株引起的心脏功能障碍提供新的诊断、治疗和调查策略。

引用次数: 0

Diabetes and associated cardiovascular complications: The role of microRNAs 糖尿病和相关心血管并发症:microrna的作用

Q4 Medicine

Cardiology Plus

Pub Date : 2023-07-01 DOI: 10.1097/cp9.0000000000000062

Mirjana T. Macvanin, Esma R. Isenovic

Diabetes mellitus (DM) refers to a complex cluster of metabolic disorders characterized by hyperglycemia caused by inadequate insulin secretion, insulin resistance, or excessive glucagon secretion. If not correctly treated, the prolonged effects of DM-associated metabolic perturbations lead to systemic vascular complications and cardiovascular disease (CVD), the principal cause of mortality among patients with DM. Given the increase in the global prevalence of diabetes, novel diagnostic and therapeutic procedures are necessary for its effective identification and treatment. Recent findings point to an important role of microRNA (miRNAs) in DM initiation and progression, as well as the occurrence of associated cardiovascular complications. miRNAs are short, highly conserved, single-stranded, non-coding RNAs that contribute to the maintenance of physiological homeostasis through the regulation of crucial processes such as metabolism, cell proliferation, and apoptosis. The increased availability of high-throughput methodologies for identifying and characterizing non-coding RNAs has led to considerable interest in miRNAs as potential biomarkers and therapeutic agents for DM. In this review, we first comprehensively detail the regulatory miRNAs involved in the pathophysiology of DM and diabetic cardiomyopathy (DCMP). Subsequently, we summarize findings regarding the utility of several of these miRNAs as potential prognostic and diagnostic biomarkers for DM and DM-associated CVD. Finally, we evaluate the potential of miRNA-based therapeutic approaches for treating DM and DCMP in the clinical setting.

糖尿病(Diabetes mellitus, DM)是指由胰岛素分泌不足、胰岛素抵抗或胰高血糖素分泌过多引起的以高血糖为特征的一组复杂的代谢紊乱。如果不正确治疗，糖尿病相关代谢紊乱的长期影响会导致系统性血管并发症和心血管疾病(CVD)，这是糖尿病患者死亡的主要原因。鉴于全球糖尿病患病率的增加，需要新的诊断和治疗方法来有效识别和治疗糖尿病。最近的研究结果指出，microRNA (mirna)在糖尿病的发生和进展以及相关心血管并发症的发生中起着重要作用。mirna是一种短的、高度保守的单链非编码rna，通过调节代谢、细胞增殖和凋亡等关键过程来维持生理稳态。越来越多的高通量方法用于识别和表征非编码rna，这使得mirna作为糖尿病的潜在生物标志物和治疗药物引起了人们的极大兴趣。在这篇综述中，我们首先全面详细介绍了参与糖尿病和糖尿病性心肌病(DCMP)病理生理学的调控mirna。随后，我们总结了这些mirna作为糖尿病和糖尿病相关心血管疾病的潜在预后和诊断生物标志物的研究结果。最后，我们评估了基于mirna的治疗方法在临床环境中治疗DM和DCMP的潜力。

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引用次数: 0

Negative methylene diphosphonate scintigraphy in biopsy-confirmed hereditary transthyretin Ala117Ser cardiac amyloidosis: a case report 活组织检查证实遗传性甲状腺转蛋白Ala117Ser心脏淀粉样变性的二膦酸亚甲基显像阴性1例

Q4 Medicine

Cardiology Plus

Pub Date : 2023-07-01 DOI: 10.1097/cp9.0000000000000058

Zejia Wu, Shuang Xia, Dunliang Ma, Liwen Li

99m Tc-pyrophosphate ( 99m Tc-PYP) scintigraphy is highly sensitive and specific for the diagnosis of transthyretin cardiac amyloidosis (ATTR-CA). Commonly used alternative tracers included 99m Tc-3,3-diphosphono-1,2-propanodicarboxylic acid ( 99m Tc-DPD) and 99m Tc-hydroxymethylene diphosphonate ( 99m Tc-HMDP). A 61-year-old Chinese man presented with signs indicative of left ventricular hypertrophy. Genetic testing revealed heterozygous transthyretin Ala117Ser mutation. Scintigraphy using 99m Tc-methylene diphosphonate failed to show myocardial uptake. Five months later, the patient underwent permanent pacemaker implantation. Tafamidis was used irregularly, and the patient died 2 years later. 99m Tc-methylene diphosphonate may not be appropriate for diagnostic use in ATTR-CA patient with transthyretin Ala117Ser mutation.

99m tc -焦磷酸显像(99m Tc-PYP)对转甲状腺素型心脏淀粉样变性(atr - ca)的诊断具有高度的敏感性和特异性。常用的替代示踪剂有99m tc -3,3-二膦-1,2-丙二羧酸(99m Tc-DPD)和99m tc -二膦酸羟亚甲基(99m Tc-HMDP)。一位61岁的中国男性表现出左心室肥厚的迹象。基因检测显示为杂合型转甲状腺素Ala117Ser突变。使用99m tc -二膦酸亚甲基显像未能显示心肌摄取。五个月后，患者接受了永久性心脏起搏器植入手术。不定期使用他法米地，患者于2年后死亡。99m tc -二膦酸亚甲基可能不适合用于甲状腺转视蛋白Ala117Ser突变的atr - ca患者的诊断。

引用次数: 0

A multi-device robotic-assisted PCI system: a proof-of concept study for left main bifurcation stenting with culotte technique in a porcine model 一种多设备机器人辅助PCI系统:猪模型左主干分叉支架术的概念验证研究

Q4 Medicine

Cardiology Plus

Pub Date : 2023-07-01 DOI: 10.1097/cp9.0000000000000060

Wenzheng Han, Ming Wang, Shaofeng Guan, Qian Gan, Weiyi Fang, Kun Xia, Xinkai Qu

Background and purpose: Robotic-assisted percutaneous coronary intervention (PCI) has been increasingly used for simple lesion. For complex lesions, extensive manual intervention is still required. This study aims to verify the stability and safety of this robot system in complex lesion under fifth-generation (5G) network before clinical trial. Methods: We developed a robotic system that allows simultaneous remote control of multiple devices using a 5G wireless network. The key feature of the system is a bionic thumb along with two-bionic forefingers. The system was tested in eight pigs (six over 18.3 km and two over 1,100 km). Two stents were placed in the left main bifurcation using the culotte technique. All procedures, barring device loading onto the robot system, including manipulation of the guiding catheter, wire adjustments, stent or balloon positioning, and notably the final kissing step, were conducted remotely. Results: The rate of procedure success was 100%, with no device-related complications. In comparison to short-distance remote control, the delay with long-distance remote control was minimal (90.9 ± 1.5 vs. 81.5 ± 2.7 ms for command data transmission; 163.2 ± 1.3 vs. 161.0 ± 1.4 ms for image transmission). The procedure time was shorter when using two pairs versus a single pair of bionic fingers (104.3 ± 10.2 vs. 126.0 ± 3.9 min), primarily due to less time needed for device loading and exchange (33.1 ± 4.2 vs. 56.1 ± 4.0 min). Conclusions: With the 5G network, long distance was not a significant barrier for robotic-assisted PCI for chronic total occlusion. A design of the independent bionic finger module enabled final kissing balloon inflation with reduced requirement for manual intervention. Whether the system could be used beyond left main bifurcation lesions requires further investigation.

背景与目的:机器人辅助经皮冠状动脉介入治疗(PCI)在单性病变中的应用越来越广泛。对于复杂的病变，仍然需要广泛的人工干预。本研究旨在临床试验前验证该机器人系统在第五代(5G)网络下复杂病变环境下的稳定性和安全性。方法:我们开发了一个机器人系统，可以使用5G无线网络同时远程控制多个设备。该系统的主要特点是一个仿生拇指和两个仿生食指。该系统在8头猪身上进行了测试(6头超过18.3公里，2头超过1100公里)。两个支架放置在左主分叉使用导管技术。所有程序，包括将设备装载到机器人系统上，包括导尿管的操作、导线调整、支架或球囊的定位，特别是最后的接吻步骤，都是远程进行的。结果:手术成功率100%，无器械相关并发症。与近距离遥控相比，远程遥控的指令数据传输延迟最小(90.9±1.5 ms vs 81.5±2.7 ms);163.2±1.3 vs. 161.0±1.4 ms图像传输)。与单对仿生手指相比，使用两对仿生手指的手术时间更短(104.3±10.2 vs 126.0±3.9 min)，主要是由于设备加载和交换所需的时间更短(33.1±4.2 vs 56.1±4.0 min)。结论:在5G网络下，远距离不是机器人辅助PCI治疗慢性全闭塞的显著障碍。独立仿生手指模块的设计使最终的接吻气球膨胀减少了人工干预的要求。该系统是否可以用于左主干分叉病变以外的病变，需要进一步研究。

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引用次数: 0