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Concept
Hybrid cardiac surgery
Summary
A hybrid cardiac surgical procedure in a narrow sense is defined as a procedure that combines a conventional, more invasive surgical part (including a skin incision) with an interventional part, using some sort of catheter-based procedure guided by fluoroscopy (or other, e.g., CT or MRI) imaging in a hybrid operating room (OR) without interruption. The hybrid technique has a reduced risk of surgical complications and has shown decreased recovery time. It can be used to treat numerous heart diseases and conditions and with the increasing complexity of each case, the hybrid surgical technique is becoming more common.
A hybrid cardiac surgery can be either a one-stage or two-stage procedure. The difference between the two is the extent of time elapsed between the two components of a hybrid surgery. A one-stage procedure is done in hybrid suite and requires a specialized operating room. In the two-stage procedure, there is a time gap between the catheter intervention and the surgical operation. The time between can vary by minutes or hours, and although unlikely, up to days and weeks. The two-stage procedure is typically done in different locations, beginning in a catheterization laboratory followed by a surgical operating room.
The first uses of the technical hybrid cardiac surgical procedures were done in the 1990's. However, there have been descriptions of such procedures earlier in the 1970's.
There are no absolute contraindications to a hybrid cardiac surgery, and the precise circumstances which indicate a hybrid surgery would be most beneficial are uncertain. However, several factors should be considered when devising a care plan.
Regarding most cardiovascular diseases, high-risk and re-operative patients are ideal candidates for a hybrid surgery. Crucial factors to acknowledge are the complexity of the disease and the possible comorbidities, such as advanced age, obesity and decreased pulmonary function. Cardiologists often use the SYNTAX score grading system to determine the complexity of the coronary artery disease and the possible surgical outcomes.
Official source
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