Hybrid Interventions

Overview

As technology has advanced, so has the ability to treat many types of congenital heart disease (CHD) in a hospital’s catheterization lab, rather than requiring open-heart surgery. In a catheter-based procedure, a thin, flexible tube (catheter) is inserted into the arteries or veins and guided to the heart to deliver treatment.

Catheter-based and open surgical techniques both have their particular advantages and potential disadvantages. Hybrid procedures allow interventional cardiologists and cardiothoracic surgeons to bring their areas of expertise together to maximize these advantages and potentially minimize the disadvantages in the treatment of cardiac and vascular problems in children and adults. Actually, the philosophy of doing hybrid procedures is not that new; however, the increasing partnership of cardiologists and surgeons has opened new doors to allow more complex combined cardiac procedures to be performed than in the past. As such, hybrid procedures represent a natural evolution in the coordinated care of patients with CHD.

Many hospitals have incorporated this philosophy of partnership in the design of the operating rooms and catheterization labs so that hybrid procedures can be performed more successfully. Both the interventional cardiologist and cardiac surgeon have special requirements for doing their jobs successfully. For the interventional cardiologist, very good X-ray imaging, quick access to the many interventional supplies used, and the ability to review X-ray images at the bedside are crucial. For the surgeon, proper air cleansing/circulation in the room to minimize infections, good lighting to visualize the surgical field, and an unencumbered environment for the anesthesiologist and other operating room staff are equally important.

Examples of hybrid procedures include the following:

• Closure of ventricular septal defects (VSDs)
• Intraoperative vascular stent placement (surgical placement of a stent in a blood vessel)
• Hybrid first stage Norwood procedure for single ventricle heart disease
• Postoperative “exit angiography” after surgical repair of vessels in the operating room.

Undoubtedly, new applications of operative and catheter-based techniques will continue to evolve, and hybrid procedures represent an exciting development in the treatment of CHD.