THE WAY FORWARD FOR ADVANCED CARDIOVASCULAR TREATMENT
Cardiovascular diseases are complex, affecting any part of the blood vessel system. This involvement can be extensive, affecting the heart, brain, abdomen, kidneys, liver- intestines and lower limbs. Often the involvement is not isolated, and two or more areas can be affected simultaneously, and both may require treatment on a priority. The most common combination seen is involvement of the heart blood vessels and the vessels of the legs. The occlusion of the heart blood vessels leads to heart attack (chest pain/ myocardial infarction), whereas involvement of the leg vessels can lead to gangrene and non-healing ulcers in the leg/ foot, leading to severe pain with minimal relief with routine pain killers. Treating the heart problem first may lead to progressive gangrene of the limb leading to limb loss/ major amputation; and treating the limb problem without treating the cardiac problem may lead to periprocedural myocardial infarction which can be life threatening. It is in these complex patient populations that the ideal use of a Hybrid Operating Theatre is noted.
What is a Hybrid OT?
The Hybrid operating room combines a surgical theatre, with all its necessary surgical instruments and equipments including the anesthesia machine, and the cath lab with its associated catheters, balloons and stents etc. add to it the ultrasound machine (dopplor, 2D echo, TEE), the IVUS machine and a host of other hardware to treat a whole gamut of other conditions. The size of the Hybrid OT is much larger compared to the regular OT or Cath lab. The staff working in the Hybrid lab are specifically trained to handle multiple roles of both the operating room and the cath lab.
Why is there a need for a Hybrid OT?
Treatment of cardiovascular diseases has traditionally been through the use of catheter based interventions – angioplasty, and open surgical procedures like valve replacements and coronary artery bypass grafting (CABG). There are certain indications to perform each of these procedures. But there are situations, more often than not, where the line is not black and white. Complex situations require complex solutions. The patient might benefit from open surgical intervention in one area while an endovascular solution may be the best for another area.
The Hybrid OT combines the best of both these operating environments, and more.
Benefits of a Hybrid OT
The most prominent benefit is treating multiple disease segments in the same session which would have otherwise required visits to the operating room and cath lab for two different procedures on two different occasions. This not only shortens the operative time, but also shortens the hospital stay and hence the overall expenses.
Another benefit of a Hybrid OT is the possibility of doing a completion angiogram to note the adequacy of the bypass. Any technical errors can be identified and corrected immediately, rather than waiting till the evening to discover the failure of the repair. Such a failure can be recognized immediately and corrected before the patient is shifted back to the ICU/ ward for further monitoring. This not only increases physician satisfaction, but is also greatly satisfying to the patient when they are provided pre- and post operative photographs of their bypass grafts.
Which all specialities benefit from a hybrid OT, what kind of procedures can be planned in a Hybrid OT?
Peripheral Vascular & Endovascular Surgery/ Interventional Radiology (CAROTID ARTERY DISEASE – BOTH EXTRACRANIAL AND INTRACRANIAL; BYPASS SURGERY ALONG WITH ANGIOPLASTY; AORTIC DISSECTIONS; COMPLEX AORTIC ANEURYSMS; PERIPHERAL ARTERIAL DISEASE; COMPLEX DEEP VENOUS DISORDERS ETC)
- Cardiology- Cardiac surgery (PTCA + CABG/ VALVE REPAIR)
- Cardiology – Vascular surgery (PTCA + VASCULAR BYPASS)
- Cardiac surgery – Endovascular Surgery (CABG/ VALVE REPAIR + EVAR/ TEVAR, ARCH DEBRANCHING
- Neurosurgery – Interventional Radiology (CEREBRAL ANEURYSMS, TUMORS, VASCULAR MALFORMATIONS)
- Complex Cancer surgery (eg. RETROPERITONEAL SURGERY REQUIRING GREAT VESSELS CONTROL AND REPAIR)
- Plastic surgery – Interventional Radiology (FREE FLAPS POST PROCEDURE VASCULARITY)
The department of Peripheral Vascular & Endovascular Surgery – Interventional Radiology, along with the department of Cardiology -Cardiac Surgery, at Apex hospital Pvt Ltd, is the first in Rajasthan to offer such state of the art technology which will immensely benefit the people of Rajasthan and adjoining states. There are very few such hybrid OTs established in the country and the majority of them are in the Delhi, Bangalore, Hyderabad and Chandigarh.