Hybrid cardiac surgery
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.
Other deciding factors may include the patient's suitable vessels for grafting, body mass index, radiographic contrast allergies, and response to antiplatelet therapies.
Such procedures are stent placement, angioplasty, fractional flow reserve, intravascular ultrasound (IVUS) and cardiac biopsy.
However, such percutaneous approaches can be challenging or even impossible because of difficult and complex anatomies (such as double-outlet right ventricle, or transposition of the great arteries, acute turns or kinks in the pulmonary arteries of tetralogy of Fallot patients) and patient characteristics/ complications (low weight, poor vascular access, induced rhythm disturbances, hemodynamic compromise).
Another important concept in hybrid procedures is completion angiography, as described above, which in the case of congenital heart disease surgery may detect residual structural lesions, thus reduce postoperative complications.
[7] Completion angiography in a hybrid OR may even induce a reduction of contrast media and ionizing radiation dose applied to the patient, as it reduces the need for post-operative examination.
This procedure has excellent outcomes particularly in younger patients at relatively low-risk and will remain the gold standard for aortic valve replacement in the upcoming years.
However, TAVI (transcatheter aortic valve implantation) has emerged as a valid alternative for patients in whom conventional surgical techniques are considered too invasive and risky.
The repair of a defected mitral valve is a potential future hybrid procedure, that is still dependent on approval of the necessary devices by the U.S. Food and Drug Administration.
Complex hybrid procedures may arise where the various parts of the mitral valve apparatus (e.g. chordae, leaflet and ring) are repaired on a beating heart in combination with purely interventional techniques (e.g. MitralClip).
Rotational angiography, providing CT-like 3D imaging with the angiographic C-arm enables the surgeon to diagnose this complication intraoperatively and correct it right away.
[3] In the hybrid two-stage procedure the total operation time is much shorter and decreases postoperative complications, however there is a risk that the aneurysm could rupture between the two stages.
[medical citation needed] In many cases for differing heart diseases and conditions the morbidity rates greatly decreased when a hybrid approach was used.
