Hybrid Operating Room: A Space Dedicated to Cross-Disciplinary Cardiac Care

When the dust settles on the Ottawa Heart Institute’s new addition in early 2018, one of the innovative new facilities to come online will be a hybrid operating room (OR). It will be a space for surgeons, interventional cardiologists, imaging specialists and other medical professionals to work side-by-side, offering streamlined and enhanced care for many cardiac patients.

A hybrid OR brings together advanced surgical facilities with the resources of a cardiac catheterization lab and expanded imaging capabilities. The cath lab is where non-surgical, catheter-based procedures such as angiograms and angioplasties are performed by interventional cardiologists. The combined facilities of a hybrid OR provide doctors with the ability to perform interventional and surgical procedures at the same time. This saves patients the burden of undergoing separate procedures with separate recovery periods.

More Efficient and Tailored Care

For example, a surgeon could perform a mitral valve repair and be joined by a cardiologist to together perform a TAVI sequentially, in the same patient during the same session, explained Marc Ruel, MD, Chief of Cardiac Surgery at the Heart Institute. Or for a patient with multiple blocked arteries, some of those blockages may be opened with stents, while others may require bypass surgery. The hybrid OR makes it possible to perform both procedures together.

Heart Institute interventional cardiologists and surgeons already collaborate in the cath lab on heart valve procedures such as transcatheter aortic valve implantations (TAVIs) and MitraClips. “For procedures like these where we work together, the hybrid operating room will be the logical place for us to do that, especially for patients who are at higher risk of complications,” said Christopher Glover, MD, interventional cardiologist and director of the Cardiac Catheterization Laboratory.

Earlier this summer, Vinod Thourani, MD, Chief of Cardiothoracic Surgery at Emory University, gave an invited lecture at the Heart Institute on hybrid ORs. In his talk, he indicated that a major advantage of the hybrid OR is that the combined resources and expertise allow for more rapid and tailored responses to unexpected complications.

Standard cath labs aren’t equipped for opening a patient’s chest in an emergency situation, but this can be done in a hybrid OR. Conversely, said Dr. Ruel, catheter-based techniques could be used in the hybrid OR to manage complications, such as a perforated internal blood vessel, that can be repaired with minimally invasive techniques, without having to resort to surgical interventions.

The enhanced imaging capabilities of the hybrid OR open up a range of possibilities for improving patient care, explained Dr. Thourani. Perhaps the most important is that doctors can verify the results of complex procedures without ever leaving the operating space.

Instant verification can speed surgical processes and improve patient safety, said Dr. Ruel. “If you’re doing a complex surgery with three or four bypasses through a small incision and because of a possible complication you want to be sure the bypasses are really doing the job you expected they would do, normally you would have to close everything up, take the patient to the ICU, then take them to the catheter lab to do an angiogram. The logistics are very difficult—it can take hours to sort out,” he explained. “Having imaging right onsite in the OR lets you immediately check the quality of what you’ve done. That’s better for the patient, faster, and more efficient for the team.”

Building on a Tradition of Collaboration

To accommodate the extensive suite of equipment and expanded staff, the Heart Institute’s hybrid OR will be twice the size of a standard OR. Up to a dozen medical professionals may need to crowd into an existing operating room, sometimes wheeling in needed equipment from other locations to provide the multidisciplinary care required for complex cases.

In the evolving world of cardiac care, Dr. Thourani sees growing overlap among cases traditionally handled by surgeons and interventional cardiologists. This will require more and more collaboration between the disciplines and new ways of thinking for surgeons, cardiologists and nurses.

To facilitate the transition to this new environment, the Heart Institute has recruited a new surgeon with specific training and experience in hybrid ORs, starting July 2017. He will act as a “concertmaster,” said Dr. Ruel, helping surgeons and interventional cardiologists work together seamlessly.

Although the Heart Institute’s hybrid operating room is a brand-new facility, the teamwork and cross-disciplinary care it will facilitate are familiar to the Heart Institute’s faculty and staff.

“This approach is completely in line with the overall philosophy of the Heart Institute and with the heart team concept we have embraced,” concluded Dr. Ruel. “We’ve always looked at providing treatment not by specialty but by multidisciplinary teams focused on the disease and the patient.”