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Role of artificial intelligence and machine learning in interventional cardiology. Curr Probl Cardiol 2023; 48:101698. [PMID: 36921654 DOI: 10.1016/j.cpcardiol.2023.101698] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/16/2023]
Abstract
Directed by two decades of technological processes and remodeling, the dynamic quality of healthcare data combined with the progress of computational power has allowed for rapid progress in artificial intelligence (AI). In interventional cardiology, AI has shown potential in providing data interpretation and automated analysis from electrocardiogram (ECG), echocardiography, computed tomography angiography (CTA), magnetic resonance imaging (MRI), and electronic patient data. Clinical decision support has the potential to assist in improving patient safety and making prognostic and diagnostic conjectures in interventional cardiology procedures. Robot-assisted percutaneous coronary intervention (R-PCI), along with functional and quantitative assessment of coronary artery ischemia and plaque burden on intravascular ultrasound (IVUS), are the major applications of AI. Machine learning (ML) algorithms are used in these applications, and they have the potential to bring a paradigm shift in intervention. Recently, an efficient branch of ML has emerged as a deep learning algorithm for numerous cardiovascular (CV) applications. However, the impact DL on the future of cardiology practice is not clear. Predictive models based on DL have several limitations including low generalizability and decision processing in cardiac anatomy.
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Aluthman U, Bafageeh SW, Ashour MA, Barnawi HI, Bogis AA, Alamri R, Elmahrouk AF, AlGhamdi SA, Ismaeil N, Shihata M, Jamjoom AA. A robotic-assisted hybrid coronary revascularization program: Establishment and early experience in the Middle East. J Card Surg 2022; 37:4783-4789. [PMID: 36349707 DOI: 10.1111/jocs.17123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/10/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Hybrid coronary revascularization (HCR) is a technique that merges coronary artery bypass grafting surgery and percutaneous coronary intervention (PCI) approaches for the treatment of multivessel coronary artery disease. The surgical component of the procedure is minimally invasive and can be done using robotic technology that avoids the need for sternotomy. Our objective is to study all patients who underwent robotic-assisted HCR (RHCR) to evaluate the feasibility and safety of the procedure during the establishment phase. METHODS This study is a retrospective chart review conducted at King Faisal Specialist Hospital and Research Centre in Jeddah (KFSRC-J). The study focuses on patients who underwent RHCR between July 2018 to December 2020. The study was approved by the institutional review board #2020-103. RESULTS Robotic-assisted HCR was performed on 78 patients (mean age, 56 years (range, 43-72 years); 89.75% males) during the study phase. Left internal mammary artery grafting was used in all patients. There was no hospital mortality, and the mean hospital and intensive care unit (ICU) stay were 5.8 and 1.4 days, respectively. We found that 93.6% of the patients had no blood transfusion. There were no major adverse cardiac events (MACE) and perioperative MI recorded. There was a 3.8% rate of postoperative complications. The percentage of surgeries converted to conventional and re-exploration for bleeding were 1.2% and 2.6%, respectively. The average operation time was 164 min. CONCLUSION This study emphasizes on the safety and effectiveness of RHCR in treating patients with multivessel coronary artery disease. Moreover, robotic-assisted hybrid coronary revascularization offers an alternative, functionally complete revascularization option to a selected group of patients with minimal surgical trauma, short hospital and ICU length of stay, quick recovery, and little to no blood transfusion requirement.
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Affiliation(s)
- Uthman Aluthman
- Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Salman W Bafageeh
- College of Medicine, King Saud bin Abdulaziz University for Health Science, Jeddah, Saudi Arabia
| | - Mohammed A Ashour
- College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hani I Barnawi
- Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Abdulbadee A Bogis
- Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Rawan Alamri
- Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Ahmed F Elmahrouk
- Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Cardiothoracic Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Nabeel Ismaeil
- Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Mohammad Shihata
- Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Ahmed A Jamjoom
- Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
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Moss S, Doyle M, Hong R, Manganas C, Peeceeyen S. Octogenarians and aortic valve surgery: surgical outcomes in the geriatric population. Indian J Thorac Cardiovasc Surg 2020; 36:134-141. [PMID: 33061112 DOI: 10.1007/s12055-019-00853-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/09/2019] [Accepted: 07/16/2019] [Indexed: 12/29/2022] Open
Abstract
Background The era of percutaneous aortic valve intervention has challenged the continuing indication for surgical aortic valve replacement (SAVR). Aim The aim of this study is to evaluate clinical outcomes of the elderly patients who underwent surgical aortic valve replacement via median sternotomy, in order to assess the impact of surgery on patient outcomes and discharge destination. Methods The study involves a retrospective observational analysis in a single centre, including all octogenarian patients who underwent aortic valve surgery between January of 2011 and July of 2016. The study assessed pre-operative co-morbidities and post-operative outcomes, including long-term mortality and discharge destination following on from surgery. Results The mean age of patients was 82.7 years (± 2.9), 67% of whom were male. The mean EuroSCORE II was 8.1 (± 7.6). The most common pre-operative co-morbidities were dyslipidaemia (82%), hypertension (80%), and ischaemic heart disease (78.8%). The median length of stay was 10 days (± 6.9 days). Discharge home occurred in 71.8% of patients, with 21.2% of patients requiring transfer to a rehabilitation facility, and 1.2% of patients required placement into an aged care facility. There were five peri-operative deaths, equating to 5.9% of the cohort. Conclusion Despite high EuroSCORE II values for the majority of our patients, our data adds to overall suggestions that the octogenarian population can be considered eligible for SAVR and should not be excluded due to age alone. The use of the EuroSCORE II index more accurately predicts adequacy for treatment however does not entirely predict overall course of events, and proceduralist discretion should still be used.
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Affiliation(s)
- Stuart Moss
- St George Hospital, 1 Grey St, Kogarah, Sydney, New South Wales 2217 Australia
| | - Mathew Doyle
- St George Hospital, 1 Grey St, Kogarah, Sydney, New South Wales 2217 Australia
| | - Regina Hong
- St George Hospital, 1 Grey St, Kogarah, Sydney, New South Wales 2217 Australia
| | - Con Manganas
- St George Hospital, 1 Grey St, Kogarah, Sydney, New South Wales 2217 Australia
| | - Sheen Peeceeyen
- St George Hospital, 1 Grey St, Kogarah, Sydney, New South Wales 2217 Australia
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Kitahara H, Hirai T, McCrorey M, Patel B, Nisivaco S, Nathan S, Balkhy HH. Hybrid coronary revascularization: Midterm outcomes of robotic multivessel bypass and percutaneous interventions. J Thorac Cardiovasc Surg 2019; 157:1829-1836.e1. [DOI: 10.1016/j.jtcvs.2018.08.126] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 07/29/2018] [Accepted: 08/13/2018] [Indexed: 10/27/2022]
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Al Harbi SA, Al Sulaiman KA, Tamim H, Al-Dorzi HM, Sadat M, Arabi Y. Association between β-blocker use and mortality in critically ill patients: a nested cohort study. BMC Pharmacol Toxicol 2018; 19:22. [PMID: 29769112 PMCID: PMC5956834 DOI: 10.1186/s40360-018-0213-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 04/30/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND β-blockers have several indications in critically ill patients and are commonly used. The aim of this study is to examine the relationship between the use of β-blockers in critically ill patients and mortality. METHODS This was a nested cohort study in which all medical-surgical ICU patients (N = 523) enrolled in a randomized clinical trial of intensive insulin therapy (ISRCTN07413772) were grouped according to β-blocker use during ICU stay. To account for the indication of β-blockers, we constructed a propensity score using selected clinically-relevant and statistically-significant variables related to β-blocker exposure and outcome. The primary endpoints were all-cause ICU and hospital mortality. Secondary endpoints were the development of severe sepsis during ICU stay, ICU and hospital length of stay, and mechanical ventilation duration. Using multivariable models, we adjusted the associations of β-blockers and these outcomes to the propensity score. RESULTS Of the 523 patients enrolled in the study, 89 (17.0%) received β-blockers during their ICU stay. There were no significant associations between β-blocker therapy and ICU mortality (adjusted odds ratio [aOR] 1.56, 95% confidence interval [CI] 0.83-2.9, P = 0.16), hospital mortality (aOR 1.09, 95% CI 0.99-1.20, P = 0.73), the risk of ICU-acquired severe sepsis (aOR 1.67, 95% CI 0.95-2.97, P = 0.08), mechanical ventilation duration (P = 0.17), or ICU length of stay (P = 0.22). However, β-blocker use was associated with increased ICU and hospital mortality among nondiabetic patients (aOR 2.93, 95% CI 1.19-7.23, and 2.43, 95% CI 1.05-5.64, respectively). CONCLUSIONS Our study showed that β-blockers during the ICU stay had no significant association with mortality or morbidity. However, β-blocker therapy was associated with increased mortality in non-diabetic patients. TRIAL REGISTRATION ISRCTN07413772 ; (dated 13.07.2005).
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Affiliation(s)
- Shmeylan A. Al Harbi
- Pharmaceutical Care Department, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Khalid A. Al Sulaiman
- Pharmaceutical Care Department, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Hani Tamim
- Pharmaceutical Care Department, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Internal Medicine, American University of Beirut- Medical Center, Beirut, Lebanon
| | - Hasan M. Al-Dorzi
- Intensive Care Department, MC 1425, King Abdulaziz Medical City – National Guard Health Affairs, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, PO Box 22490, Riyadh, 1426 Kingdom of Saudi Arabia
| | - Musharaf Sadat
- Intensive Care Department, MC 1425, King Abdulaziz Medical City – National Guard Health Affairs, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, PO Box 22490, Riyadh, 1426 Kingdom of Saudi Arabia
| | - Yaseen Arabi
- Intensive Care Department, MC 1425, King Abdulaziz Medical City – National Guard Health Affairs, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, PO Box 22490, Riyadh, 1426 Kingdom of Saudi Arabia
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Abstract
Over the past decade there has been an exponential increase in the number of robotic-assisted surgical procedures performed in Australia and internationally. Despite this growth, there are no level I or II studies examining the anaesthetic implications of these procedures. Available observational studies provide insight into the significant challenges for the anaesthetist. Most anaesthetic considerations overlap with those of non-robotic surgery. However, issues with limited patient access and extremes of positioning resulting in physiological disturbances and risk of injury are consistently demonstrated concerns specific to robotic-assisted procedures.
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Pourdjabbar A, Ang L, Behnamfar O, Patel MP, Reeves RR, Campbell PT, Madder RD, Mahmud E. Robotics in percutaneous cardiovascular interventions. Expert Rev Cardiovasc Ther 2017; 15:825-833. [PMID: 28914558 DOI: 10.1080/14779072.2017.1377071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The fundamental technique of performing percutaneous cardiovascular (CV) interventions has remained unchanged and requires operators to wear heavy lead aprons to minimize exposure to ionizing radiation. Robotic technology is now being utilized in interventional cardiology partially as a direct result of the increasing appreciation of the long-term occupational hazards of the field. This review was undertaken to report the clinical outcomes of percutaneous robotic coronary and peripheral vascular interventions. Areas covered: A systematic literature review of percutaneous robotic CV interventions was undertaken. The safety and feasibility of percutaneous robotically-assisted CV interventions has been validated in simple to complex coronary disease, and iliofemoral disease. Studies have shown that robotically-assisted PCI significantly reduces operator exposure to harmful ionizing radiation without compromising procedural success or clinical efficacy. In addition to the operator benefits, robotically-assisted intervention has the potential for patient advantages by allowing more accurate lesion length measurement, precise stent placement and lower patient radiation exposure. However, further investigation is required to fully elucidate these potential benefits. Expert commentary: Incremental improvement in robotic technology and telecommunications would enable treatment of an even broader patient population, and potentially provide remote robotic PCI.
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Affiliation(s)
- Ali Pourdjabbar
- a Division of Cardiovascular Medicine , University of California, San Diego Sulpizio Cardiovascular Center , La Jolla , CA , USA
| | - Lawrence Ang
- a Division of Cardiovascular Medicine , University of California, San Diego Sulpizio Cardiovascular Center , La Jolla , CA , USA
| | - Omid Behnamfar
- a Division of Cardiovascular Medicine , University of California, San Diego Sulpizio Cardiovascular Center , La Jolla , CA , USA
| | - Mitul P Patel
- a Division of Cardiovascular Medicine , University of California, San Diego Sulpizio Cardiovascular Center , La Jolla , CA , USA
| | - Ryan R Reeves
- a Division of Cardiovascular Medicine , University of California, San Diego Sulpizio Cardiovascular Center , La Jolla , CA , USA
| | | | - Ryan D Madder
- c Frederik Meijer Heart & Vascular Institute, Spectrum Health , Grand Rapids , MI , USA
| | - Ehtisham Mahmud
- a Division of Cardiovascular Medicine , University of California, San Diego Sulpizio Cardiovascular Center , La Jolla , CA , USA
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Mahmud E, Pourdjabbar A, Ang L, Behnamfar O, Patel MP, Reeves RR. Robotic technology in interventional cardiology: Current status and future perspectives. Catheter Cardiovasc Interv 2017; 90:956-962. [DOI: 10.1002/ccd.27209] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 06/24/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Ehtisham Mahmud
- Division of Cardiovascular Medicine; University of California, San Diego Sulpizio Cardiovascular Center; La Jolla California
| | - Ali Pourdjabbar
- Division of Cardiovascular Medicine; University of California, San Diego Sulpizio Cardiovascular Center; La Jolla California
| | - Lawrence Ang
- Division of Cardiovascular Medicine; University of California, San Diego Sulpizio Cardiovascular Center; La Jolla California
| | - Omid Behnamfar
- Division of Cardiovascular Medicine; University of California, San Diego Sulpizio Cardiovascular Center; La Jolla California
| | - Mitul P. Patel
- Division of Cardiovascular Medicine; University of California, San Diego Sulpizio Cardiovascular Center; La Jolla California
| | - Ryan R. Reeves
- Division of Cardiovascular Medicine; University of California, San Diego Sulpizio Cardiovascular Center; La Jolla California
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Pourdjabbar A, Ang L, Reeves RR, Patel MP, Mahmud E. The Development of Robotic Technology in Cardiac and Vascular Interventions. Rambam Maimonides Med J 2017; 8:RMMJ.10291. [PMID: 28459664 PMCID: PMC5548109 DOI: 10.5041/rmmj.10291] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Robotic technology has been used in cardiovascular medicine for over a decade, and over that period its use has been expanded to interventional cardiology and percutaneous coronary and peripheral vascular interventions. The safety and feasibility of robotically assisted interventions has been demonstrated in multiple studies ranging from simple to complex coronary lesions, and in the treatment of iliofemoral and infrapopliteal disease. These studies have shown a reduction in operator exposure to harmful ionizing radiation, and the use of robotics has the intuitive benefit of alleviating the occupational hazard of operator orthopedic injuries. In addition to the interventional operator benefits, robotically assisted intervention has the potential to also be beneficial for patients by allowing more accurate lesion length measurement, stent placement, and patient radiation exposure; however, more investigation is required to elucidate these benefits fully.
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Torregrossa G, Kanei Y, Puskas J. Hybrid robotic coronary artery bypass grafting: how do we do it. Ann Cardiothorac Surg 2016; 5:582-585. [PMID: 27942492 DOI: 10.21037/acs.2016.11.06] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Gianluca Torregrossa
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Yumiko Kanei
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, NY, USA
| | - John Puskas
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, NY, USA
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