Robotic-assisted percutaneous coronary intervention in the COVID-19 pandemic

Abstract

Coronavirus disease-2019 (COVID-19) has a profound impact on the health care system worldwide. In the COVID-19 pandemic, hospitals are required to halt elective surgeries and procedures for preventing nosocomial infections and saving medical resources. In these situations, emergency procedures are required for life-threatening cardiovascular diseases such as acute coronary syndrome and cardiogenic shock. To prevent the spread of COVID-19, a social distance is essentially required. In ordinary percutaneous coronary intervention (PCI), operators manipulate the devices standing at the patient's tableside during the whole procedure, which may involve a certain risk of exposure to patients with COVID-19. A robotic-assisted PCI (R-PCI) allows operators to manipulate devices remotely, sitting at a cockpit located several meters away from the patient, and in addition, the assistant can be at the foot of the bed, much further from the access site. R-PCI can help to minimize the radiation exposure and the amount of person-to-person contact, and consequently may reduce the risk for the exposure to the virus.

Keywords: Acute coronary syndrome; COVID-19; Percutaneous coronary intervention; Robotic-assisted procedures.

Graphical abstract

Fig. 1

The CorPath GRX system. (a) The bedside unit consists of a single-use cassette, articulating arm, and robotic drive. (b) An operator remotely controls the movement of percutaneous coronary intervention devices, sitting down at a radiation shielded cockpit. (c) The cockpit contains a console with joysticks and touchscreen controls to control movement of the balloon/stent delivery system, guidewire, or guiding catheter. (d) Overview of the CorPath GRX system in the catheterization laboratory. The cockpit is 4 meters away from the patient.

Fig. 2

Chest X-ray and thoracic computed tomography (CT) of the case. (a) A chest X-ray and (b) a thoracic CT showed bilateral ground-glass shadow and pleural effusion. A central venous catheter is placed in the superior vena cava, and an intubation tube is placed in the trachea.

Fig. 3

Electrocardiogram of the case. An electrocardiogram showed ST elevation in V3-6 leads and abnormal Q wave in Ⅰ, Ⅱ, Ⅲ, aVF, and V3-6 leads.

Fig. 4

Coronary angiography of the case. Coronary angiography showed a tight stenosis in right coronary artery (a) and thrombotic lesions in left anterior descending artery and left circumflex artery (b). An excellent result was obtained by robotic assisted-PCI (c). LCA, left coronary artery; LAD, left anterior descending artery; LCx, left circumflex artery; PCI, percutaneous coronary intervention; RCA, right coronary artery.

Fig. 5

An overview image during the procedure in a patient suspected COVID-19. The operator stayed at the cockpit (red arrow) 4 meters away from the table (blue arrow), and the assistants also maintained a sufficient distance from the patient.