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Physicians Update

Fall 2008

Hybrid Procedure Rooms Bring Diverse Specialists Together


Hybrid Procedure Room Advances in imaging and devices, along with an ever-increasing alliance between interventional cardiologists and surgeons, are changing the face of many cardiovascular procedures. That change is reflected in the design of the procedure rooms in the Cardiac Interventional Suite at Ronald Reagan UCLA Medical Center. Two of the six procedure rooms in the new hospital are considered “hybrid” operating rooms, where teams of cardiologists, cardiothoracic surgeons and vascular surgeons can work together to perform any of a number of interventional and surgical procedures in a single setting. The rooms include state-of-the-art imaging capabilities as well as the lighting and equipment necessary for open-heart procedures. “The hybrid OR meets the high standards of both a cardiac catheterization lab and an operating room,” explains Richard J. Shemin, M.D., chief of cardiothoracic surgery at UCLA. “This allows us to devise procedures in which cardiologists and surgeons can collaborate in the same room without compromising the environment and the equipment they require to treat cardiac conditions. The result will be less-invasive and more efficient care with less need for repeat procedures.”

Blending specialties

The disciplines of surgery and interventional cardiology have been blending for a number of years, to the point where traditional hospital layouts are becoming outdated. “There are now cardiologists who do peripheral vascular procedures and vascular surgeons who are doing more of their procedures percutaneously, because it’s less invasive,” notes Jonathan M. Tobis, M.D., UCLA interventional cardiologist. “As a result, the catheterization lab may not be feasible for everything the cardiologist is doing, and the operating room may not have everything the surgeon needs. Given this kind of overlap, these hybrid rooms are likely to become the norm.”

Seamless team

EKG in Hybrid Operating RoomAmong the categories of procedures that lend themselves well to the hybrid rooms is the treatment of cardiac arrhythmias. UCLA is one of the few centers with the ability to map arrhythmias during surgery. In the new facility, if a patient needs an ablation procedure, the electrophysiologist and cardiac surgeon are able to work together to perform the mapping, ablation and minimally invasive surgery in the same setting. “Interventionalists and cardiac surgeons can work as a seamless team coming up with a comprehensive approach to solving a problem,” says Kalyanam Shivkumar, M.D., Ph.D., director of the UCLA Cardiac Arrhythmia Center. “This is disease-oriented management instead of specialty-oriented management.” Similarly, for patients who need a valve replacement that requires an artery bypass, rather than necessitating an open procedure the new rooms offer the possibility of having a cardiologist deploy a stent and the surgeon replacing the valve through a small incision. Other catheter-based techniques such as percutaneous heart valves also become more feasible. New procedures Abdominal-aortic-aneurysm repairs represent another procedure in which patients will benefit from the ability of the surgical and interventional teams to work together in one setting. “Traditionally, these were done with an open laparotomy in the OR,” says Michael S. Lee, M.D., UCLA interventional cardiologist. “Now, rather than cutting open the abdomen, we can work through an artery of the leg. By having a room that allows the procedures of a catheterization lab as well as OR capabilities, a multidisciplinary team can perform the procedures.” The new rooms also enable Dr. Lee and colleagues to perform peripheral angioplasties. Beyond the hybrid procedures currently being performed, the hybrid ORs will facilitate UCLA’s leadership role in devising the procedures of the future. Among other things, the new environment will be used for research protocols designed to study new approaches. “The hybrid OR creates a great deal of potential for looking at creative ways of treating conditions better than we have in the past,” Dr. Shemin says.

STEMI Sites at UCLAUCLA Hospitals Certified as STEMI Sites

UCLA’s Westwood and Santa Monica hospital emergency departments have been certified by the Los Angeles County Department of Health Services as target facilities for victims of high-risk ST-elevation myocardial infarction (STEMI). When county paramedics identify STEMI patients through a field electrocardiogram, they are trained to bring those patients directly to the nearest STEMI receiving center, which has the cardiac catheterization teams and full percutaneous cardiac intervention capability necessary to quickly clear the blockage. The goal is to open the artery within 90 minutes of the onset of symptoms.

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