Planning a Cardiovascular Hybrid Operating Room: the Technical Point of View

  • Georg Nollert
  • Sabine Wich
DOI: https://doi.org/10.1532/HSF98.20091033

Abstract

Introduction: The integration of interventional techniques into cardiovascular surgery requires angiographic imaging capabilities in the operating room. A deep understanding of the technology and its implication for the surgical workflow is scarce.

Methods and Results: Before planning a hybrid operating room, a clear vision for the utilization should be established. Commonly, the theaters are in interdisciplinary usage by interventionalists, anesthesiologists, and surgeons of various disciplines. The multitude of requirements determines necessary resources—location, space, and imaging equipment. Besides fluoroscopy, intraoperative 3D imaging with the angiography system and its combination with fluoroscopy evolves as a very important imaging modality enabling the surgeon to navigate in 3D anatomy.

Conclusion: With the growing trend toward endovascular procedures during surgery, the hybrid operating room will become an integral part of every cardiovascular center. This new operating room concept enables new cardiac surgery therapies and will play a vital role for minimally invasive surgery. Careful planning and professional expertise is a key factor for every hybrid room project.

References

Bacha EA, Daves S, Hardin J, et al. 2006. Single-ventricle palliation for high-risk neonates: the emergence of an alternative hybrid stage I strategy. J Thorac Cardiovasc Surg 131:163-171.e2.\nBacha EA, Marshall AC, McElhinney DB, del Nido PJ 2007. Expanding the hybrid concept in congenital heart surgery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 146-5.\nBashore TM, Bates ER, Berger PB, et al. 2001. American College of Cardiology/Society for Cardiac Angiography and Interventions Clinical Expert Consensus Document on cardiac catheterization laboratory standards. A report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 37:2170-214.\nBenjamin ME 2008. Building a modern endovascular suite. Endovascular Today 3:71-8.\nBiasi L, Ali T, Ratnam LA, Morgan R, Loftus I, Thompson M 2009. Intra-operative DynaCT improves technical success of endovascular repair of abdominal aortic aneurysms. J Vasc Surg 49:288-95.\nBisleri G 2008. Combined surgical and interventional electrphysiology approaches to atrial fibrillation: the hybrid ablation procedure. Presented at the 2008 Transcatheter Cardiovascular Therapeutics (TCT) Meeting, Washington, DC, October 12-15.\nBonatti J, Schachner T, Bonaros N, et al. 2008. Simultaneous hybrid coronary revascularization using totally endoscopic left internal mammary artery bypass grafting and placement of rapamycin eluting stents in the same interventional session. The COMBINATION pilot study. Cardiology 110:92-5.\nBonatti J, Vassiliades T, Nifong W, et al. 2007. How to build a cath-lab operating room. Heart Surg Forum 10:E344-8.\nEagleton MJ, Schaffer JL 2007. The vascular surgery operating room. Endovascular Today 8:25-30.\nGutgesell HP, Lim DS 2007. Hybrid palliation in hypoplastic left heart syndrome. Curr Opin Cardiol 22:55-9.\nHamm CW, Bösenberg H, Brennecke R, et al. 2001. Guidelines for equipping and managing heart catheter rooms (1st revision). Issued by the governing body of the German Society of Cardiology-Heart and Cardiovascular Research. Revised by order of the Committee of Clinical Cardiology [in German]. Z Kardiol 90:367-76.\nHirsch R 2008. The hybrid cardiac catheterization laboratory for congenital heart disease: from conception to completion. Catheter Cardiovasc Interv 71:418-28.\nKapadia SR 2008. Role of CT angiography to evaluate patient eligibility and guide transcatheter aortic valve eligibility. Presented at the 2008 Transcatheter Cardiovascular Therapeutics (TCT) Meeting, Washington, DC, October 12-15.\nMack MJ 2008. Intraoperative coronary graft assessment. Curr Opin Cardiol 23:568-72.\nPeeters P, Verbist J, Deloose K, Bosiers M 2008. The catheterization lab of the future. Endovascular Today 3:94-6.\nReicher B, Poston RS, Mehra MR, et al. 2008. Simultaneous "hybrid" percutaneous coronary intervention and minimally invasive surgical bypass grafting: feasibility, safety, and clinical outcomes. Am Heart J 155:661-7.\nSchermerhorn ML, O'Malley AJ, Jhaveri A, Cotterill P, Pomposelli F, Landon BE 2008. Endovascular vs. open repair of abdominal aortic aneurysms in the Medicare population. N Engl J Med 358:464-74.\nSikkink CJ, Reijnen MM, Zeebregts CJ 2008. The creation of the optimal dedicated endovascular suite. Eur J Vasc Endovasc Surg 35:198-204.\nSivakumar K, Krishnan P, Pieris R, Francis E 2007. Hybrid approach to surgical correction of tetralogy of Fallot in all patients with functioning Blalock Taussig shunts. Catheter Cardiovasc Interv 70:256-64.\nSternbergh WC 3rd, Tierney WA, Money SR 2004. Importance of access to fixed-imaging fluoroscopy: practice implications for the vascular surgeon. J Endovasc Ther 11:404-10.\nten Cate G, Fosse E, Hol PK, Samset E, Bock RW, McKinsey JF, Pearce BJ, Lothert M 2004. Integrating surgery and radiology in one suite: a multicenter study. J Vasc Surg 40:494-9.\nVahanian A, Alfieri OR, Al-Attar N, et al. 2008. Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European Association of Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur J Cardiothorac Surg 34:1-8.\nWalsh SR, Tang TY, Sadat U, et al. 2008. Endovascular stenting versus open surgery for thoracic aortic disease: systematic review and meta-analysis of perioperative results. J Vasc Surg 47:1094-8.\nWalther T, Chu MW, Mohr FW 2008. Transcatheter aortic valve implantation: time to expand? Curr Opin Cardiol 23:111-6.\n
Published
2009-06-22
Issue
Vol 12 No 3 (2009)
Section
Articles

Author Disclosure & Copyright Transfer Agreement

In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.

A current form follows:

The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.

However, Publisher grants back to the author(s) the following:

  1. The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
  2. The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
  3. The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
  4. The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
  5. The right to make oral presentations of material from this work.

Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.

I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.

I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).

I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.

Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).

Most read articles by the same author(s)