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