Hybrid Cardiac Catheterization Lab
“This lab is as state of the art as state of the art gets,” said Renato Santos, MD, describing Wake Forest Baptist Medical Center’s (WFBMC) hybrid cardiac catheterization lab. WFBMC is the first medical center in the region to feature a lab that supports integrated surgical and catheterization procedures. The hybrid lab is equipped with the lighting, sterile field, and anesthesia capabilities required for open-heart surgeries coupled with the sophisticated imaging technology to support the most advanced percutaneous cardiovascular interventions. It creates an opportunity for a cardiovascular surgeon and interventional cardiologist to perform collaborative procedures on patients during a single procedure, reducing the need for multiple surgeries.
“This lab offers patients, particularly high-risk patients, the most advanced therapies available for their specific cardiovascular lesions while minimizing procedural risk,” said cardiac surgeon Edward Kincaid, MD.
One of the first patients to benefit from the hybrid lab was a woman with a transected aorta who was transported to the lab where Drs. Kincaid and Santos performed an emergency thoracic endovascular aneurysm repair (TEVAR). “She was in extremely critical condition,” said Dr. Santos, “and if the hybrid lab were not available, she would have undergone the trauma of several hours of open surgery and a lengthy recovery. Endovascular stenting offered this patient a less physiologically disruptive treatment option. She walked into my office for a checkup recently and her recovery has been exemplary.”
Patients such as this are the beneficiaries of the cutting edge technology, advanced surgical skills of cardiac surgeons and interventional cardiologists, and the support of a smoothly functioning interdisciplinary team of anesthesiologists, nurses and technicians. Examples of hybrid lab procedures include valve repair with coronary artery bypass graft (CABG), percutaneous valve procedures as well as endovascular repairs of abdominal (EVAR) and thoracic aorta (TEVAR) aneurysms and hybrid peripheral vascular disease procedures.
The hybrid lab is the culmination of surgical techniques and technologies that have been developed to treat coronary artery disease, peripheral vascular disease, aneurysms and valve disorders over the last two decades. “We are constantly striving for minimally invasive or less invasive surgery, more safety, more integration and efficiency, and this lab represents those efforts,” said Santos.
In a recent case, Dr. Kincaid performed a subclavian bypass, which required surgical skills and a sterile field before he and Dr. Santos could perform a TEVAR. A bank of monitors behind both Kincaid and Santos made it possible for each to see what the other was doing. The imaging system in the hybrid lab is also integrated with the hospital systems, so physicians can pull up CT scans and compare the 3-D CT reconstructions with the live images. “With all of that data, we were able to position the aneurysm graft perfectly,” added Santos.
The icing on the cake is the ability to use the imaging technology to transmit images to a lecture hall adjacent to the lab, so students, nurses and other physicians can watch the procedure live without having to scrub in.
“The hybrid lab is the best of both worlds. We can combine minimally invasive cardiac surgery with percutaneous treatment of aortic and cardiac disease in a single operation, which minimizes recovery time and improves patient outcomes and satisfaction,” said Dr. Kincaid, “and we can convert to an open surgery in an emergency situation. We are excited that the Heart Center at WFBMC is able to offer our referring physicians better treatment options for their patients involving ever-less-invasive approaches.”