Hybrid Surgical Procedures

The convergence of surgery and imaging is most commonly seen in Interventional Radiology procedures such as peripheral radiographic angiography and neuroangiography. Also, in interventional cardiology procedures such as cardiac catheterization and electrophysiology (EP) studies. In addition, a host of endoscopic, endovascular and transluminal procedures also integrate therapeutic interventions with various forms of image guidance, and are consequently also candidates for inclusion within the integrated interventional platform of a Hybrid Operating Suite.

Hybrid Surgical Procedures include:

• Hybrid Aortic Arch Procedures
• Percutaneous LVAD- TandemHeart
• Transcatheter Aortic Valves (TAVR & TAVI)
• Transcatheter Mitral Valve Procedures
• Hybrid  CABG/PCI
• Hybrid Aortic Valve /PCI 
• Completion Angiography post CABG
• Peripheral Vascular Procedures
• Thoracic and Abdominal Aortic Endografting
• Hybrid catheter/thoracoscopic Maze for AF
• Hybrid Endovascular Procedures

​VIDEO: Hybrid Operating Room Procedural Benefits by The Cleveland Clinic

What are the benefits of the cardiovascular Hybrid OR Suite? 

The following benefits can be derived from the cardiovascular Hybrid OR Suite and they are:

1. Minimally invasive surgery together with catheter-based image-guided intervention in the Hybrid OR Suite will allow for a safe and sterile environment and also allow a fully-integrated heart team comprising of interventional cardiologist, cardiac and vascular surgeons and anaesthetists backed by a full set of supporting staff to achieve better outcome and reduce operative mortality and morbidity and also reduction of major complications. The minimal invasive surgery also eliminates the need for big surgical openings and subsequent scars.
2. Very high risk patients previously deemed unsuitable for surgical or catheter-based intervention especially the elderly patients with more complex heart and valvular diseases can now have these procedures done safely, as in case of complications, a conversion from cathether based intervention to full surgery is possible in the same room.
3. Improved speed of recovery
4. Saves time and money

What type of procedures can be done in the cardiovascular Hybrid OR Suites?

Often, aortic aneurysms are coincidentally diagnosed during a routine check up or a medical examination for some other reason. Once you are suspected with an aneurysm, your doctor will have to determine the location of the aneurysm, how fast it is growing and how serious the condition is.

1. Emergency conversion of a catheterbased coronary intervention to a bypass operation for very high risk patients (e.g. acute myocardial infarction). A Hybrid OR Suite will allow the cardiologist to quickly convert from a catheter-based intervention to an open-heart bypass surgery if the need arises. This is potentially life-saving as time is of the essence especially in a very ill patient as his or her condition can deteriorate rapidly while waiting and being transferred to the operating theatre for an emergency bypass operation. The patient-centric set up in the Hybrid OR Suite eliminates hassles of moving the patient to another operating theatre which may compromise the patient. Such condition includes acute intervention in a heart attack, difficult angioplasty of complex coronary artery disease with potential failure and high risk of complications resulting in compromisation of the cardiac function.
2. Hybrid coronary revascularization - minimally invasive coronary bypass surgery combined with catheter-based coronary intervention in complex multi-vessel coronary artery disease. In this situation, the patient with complex multi-vessel disease can undergo a minimal invasive roboticassisted coronary artery bypass surgery with a small incision made on the left side of the chest to allow for bypass of the left anterior descending artery (which is the main life line of the heart) followed by the deployment of coronary stents to the rest of the other remaining blood vessels. This combination will reduce the operation time, improve safety and outcome and also allow for a faster recovery with a shorter stay in the hospital. The usual hospitalisation stay for full open coronary artery bypass surgery can be anything between 7 to 10 days, whereas for this hybrid procedure, within 4 to 5 days, the patient can be discharged from the hospital. They are 7 times more likely to return to work within 1 month instead of the usual 3 months for a standard coronary bypass surgery.
3. Intraoperative coronary graft assessment. Early occlusion can occur after coronary artery bypass grafting. Frequency of immediate graft closure rate is between 5 to 12% and a 1-year closure rate of 20 – 30%. Intraoperative coronary angiography offers the “gold standard” option for immediate graft assessment. The detection of immediate graft closure allows the surgeon to revise the graft immediately.
4. Hybrid valve surgery. Transcatheter aortic valve replacement is fast becoming one of the leading cuttingedge technology for the treatment of high risk elderly patient with narrowing of the aortic valve which may preclude them from open-heart valve replacement. The procedure is called TAVI i.e. Transcatheter Aortic Valve Implantation (see later section). This is even more relevant when the patient has concomitant coronary artery disease that requires revascularization which can be done more safely at the same time.
5. Hybrid Endovascular stenting for aortic aneurysm repair which involves the placement of a covered stent within an enlarged aortic aneurysm sac to exclude the blood flow and to prevent fatal rupture. Endovascular stenting has emerged as an alternative to open repair in patients requiring surgery for thoracic aortic aneurysm, dissections, trauma and other pathology. Endovascular stent grafting improves perioperative mortality and neurological complications.
6. Hybrid surgical and catheter atrial fibrillation ablation. Atrial fibrilaltion is an abnormal rhythm condition where the upper chamber of the heart instead of contracting, fibrillates. The potential risk of such an abnormal rhythm is stroke which may be as high as 50% to 70% in the elderly aged group. One of the ways to deal with this is to treat the patient with blood-thinning medications but this potentially may cause bleeding especially in the brain and stomach. The ability to perform a surgical and catheter AF ablation to eliminate the mechanisms causing the abnormal rhythm may potentially result in the ability to prevent patient from going into this abnormal rhythm and therefore prevent stroke. The success rate with this combination therapy is better than both as standalone procedures.
7. Endovascular limb salvage. Peripheral arterial disease (PAD) is increasingly being recognised in the Asian population especially associated with long-standing diabetes mellitus, hypertension and high cholesterol. Severe PAD of the lower limbs can lead to calf pain on walking or rest and gangrene needing limb amputation. Combining surgical bypass and endovascular therapy can improve blood supply to the limb resulting in limb salvage yet ensuring safety and outcome.
8. Hybrid therapy for congenital heart disease. Difficult and complex congenital heart anatomies can be undertaken combining intervention and surgery into a single therapeutic procedure resulting in reduction of complexity, cardiopulmonary bypass time, risk and improved outcomes.
9. Pacemaker and ICD implantation. Pacemaker and implantable cardioverter defibrillator (ICD) can be optimally implanted in the Hybrid OR Suite because of the more sophisticated imaging system that offers superior angulation and imaging capabilities yet maintaining higher sterile standards compared to the normal cath lab.
10. Interdisciplinary use. Neurointervention using the Brain Lab software allow for integration of intra-operative angiography and image-guided surgery (IGS). Image-guided intraoperative angiography can enhance both neurosurgery and spinal surgery.

Hybrid OR Suites bring together the best of two worlds by combining all the advantages of a modern Cath Lab with the advanced high definition imaging system and the most up-to-date Surgery Operating Theatre. It is the place where the future of treatment is realized now! It sets in motion a paradigm shift that brings together an integrated heart team comprising of the Interventional Cardiologists, Cardiothoracic Surgeons and Vascular Radiologists to work together on the same patient in the same place to achieve the best outcome with increased safety.

VIDEO: Discussion of the Clinical Benefits of the Hybrid Operating Room Environment:

VIDEO: Aortic Valve Replacement in the Hybrid Operating Room

J.M. Keckler Medical Co. - Hybrid Operating Room Consultants

staff@kecklermedical.com - 1.800.523.1010

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