Impact of Robotic Automation on Coronary Wiring Efficiency in Experienced and Inexperienced Operators
Malav J Parikh, MD, Spectrum Health/Michigan State University Program, Grand Rapids, MI
Malav J Parikh, MD1, Stephen E Wilkinson, MD1, Lahdan Refahiyat, MD1, Jose Antonio Rios Salcido1, David Bryska, MD1 and Ryan D. Madder, M.D., FSCAI2, (1)Spectrum Health/Michigan State University Program, Grand Rapids, MI, (2)Corewell Health, Ada, MI
Background
Whereas successfully advancing a guidewire within a coronary artery traditionally depended upon an operator’s experience and skill, wiring coronary arteries can now be accomplished robotically. Automated robotic wiring techniques, having recently become available, may minimize the skill and experience needed to successfully navigate a coronary guidewire. This study compared the efficiency of automated robotic wiring among experienced interventional cardiologists and inexperienced general cardiology fellows.
Methods
An
ex vivo model was constructed in a cardiovascular simulation laboratory to simulate coronary side branch wiring. To reach the target side branch in the model, operators had to advance a coronary guidewire across two sequential 90-degree angles. Wiring attempts were made using a robotic system with a rotate-on-retract (ROR) automated wiring maneuver enabled, which automatically rotates the guidewire upon retracting the joystick to redirect the wire tip. The primary outcome was wiring time, defined as time to advance the guidewire from the guide catheter to the target side branch.
Results
Among 11 operators (6 interventional cardiologists and 5 general cardiology fellows), the coronary guidewire was successfully advanced to the target location in 110 consecutive attempts using ROR (mean wiring time 52.1 ± 41.5 s). Excessively long wiring times of ³120 seconds occurred in 8.3% of attempts by interventional cardiologists and in 6.0% of attempts by cardiology fellows (p=0.73). Using ROR, wiring times among cardiology fellows (46.6 ± 26.3 s) were not significantly different than those of interventional cardiologists (56.4 ± 17.9 s, p=0.51).
Conclusions
Using an automated robotic wiring maneuver, inexperienced general cardiology fellows achieved wiring efficiencies not significantly different than those of experienced interventional cardiologists. Additional studies are required to determine whether robotic automation, including ROR and other novel automated robotic maneuvers, will enable less experienced operators to wire coronary arteries with an efficiency and skillset of more advanced operators.