Hybrid operating rooms for cardiac procedures

A common worry of cardiologists as well as their patients undergoing major catheter interventional procedures is regarding the urgent need for surgical intervention. Usually interventional procedures like balloon angioplasty (fixing up blocks in blood vessels with small catheters or tubes introduced into the blood vessels) are done in the cardiac catheterisation laboratory. If the procedure is not successful or when there is a complication requiring urgent surgical correction, the person has to be shifted to the cardiac surgery theater quickly. Very often there can be logistic issues in shifting a critically ill person, though with advanced interventional technologies which are available now, this is quite a rare occurrence. It is to counter this problem that hybrid operating rooms are being designed. This enables quick switching over from an interventional cardiology approach to a surgical approach without moving the subject from the operating table (or the cath lab table to be precise). Usually cath lab tables are not suited for surgeries and operating tables are not suitable for cath lab procedures as they are not meant for x-ray fluroscopy. Design of a hybrid suite is in such a way that both cardiac catheterisation and angiography with fluroscopy as well as surgical intervention is easily performed. Moreover an increasing number of procedures are being electively designed for hybrid suites. Examples include perventricular closure of ventricular septal defect, percutaneous aortic valve replacement and endovascular repair of aortic aneurysm. In perventricular closure of ventricular septal defect, right ventricle (lower chamber of the heart) is exposed surgically and a catheter based device is used during the operation to close the defect in the septum (separating wall between left and right ventricles). In percutaneous aortic valve replacement, it could be either a femoral or trans apical approach. In femoral approach, the artery (blood vessel carrying oxygenated blood) in the thigh is surgically exposed and further procedure of valve replacement is done using a catheter based device. Trans apical approach involves making a small operation in the lower left portion of the chest where the heart beat is felt and then introducing the device directly to the left ventricle by a catheter based approach. Endovascular repair of aortic aneurysm (enlargement of the main blood vessel of the body carrying oxygenated blood) also involves opening up of the femoral artery in the thigh surgically and further procedure is by catheter based technique. The latter two procedures – endovascular repair of aortic aneurysm and percutaneous aortic valve replacement by the femoral approach can be done in the conventional cardiac catheterisation laboratory as well, without going for a hybrid suite because the surgical exposure is only minimal in these cases.