The Brigham and Women’s Hospital (BWH) Cardiovascular Center is pioneering development of new hybrid therapies. Combining percutaneous interventions and open surgical procedures (conventional or minimally invasive), hybrid therapy offers safe, effective, and durable therapy with minimal surgical trauma for selected patients.
In a recently published BWH study (JACC, Vol. 45, No. 1, 2005, January 4, 2005:14-8), the principal finding showed that "hybrid" initial percutaneous coronary intervention followed by a staged valve surgery can be an excellent alternative to conventional high-risk CABG/valve surgery in patients who present after acute coronary syndromes and also in some patients who require complex re-operative valve surgery.
Patient Benefits
Hybrid procedures generally reduce operating time, and patients experience faster recoveries and less operative trauma. Lawrence H. Cohn, MD, Chief of the BWH Division of Cardiac Surgery, notes that hybrid procedures will be especially beneficial for fragile, elderly, and other high-risk patients. “As the overall population ages, the demand for less traumatic hybrid strategies will surely increase dramatically,” says Dr. Cohn.
Hybrid Strategies for Cardiac Care
Examples of hybrid strategies offered at BWH include:
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A combination of open and percutaneous electrophysiology procedures;
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A combination of minimally invasive valve repair and stenting for coronary lesions;
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A combination of revascularization techniques involving both stenting and robotically-augmented mammary artery LAD bypass;
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A combination of stenting for thoracic aortic aneurysm repair and other minimally invasive cardiac procedures.
Furthermore, within two to three years, non-surgical catheter-based percutaneous valve repair techniques – available experimentally today – will probably receive FDA approval. “We are excited to be able to offer our referring physicians better treatment options for their patients involving ever-less-invasive approaches as a result of tremendous clinical and technological advances,” says Campbell Rogers, MD, Director of the BWH Cardiac Catheterization Laboratory.
Cardiology Expertise
BWH is uniquely able to develop and offer new and innovative hybrid therapies with:
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Renowned cardiac surgeons who have performed one of the largest series of minimally invasive valve procedures — almost 1,400 minimally invasive aortic and mitral repair and replacement cases — in the U.S.;
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Cutting-edge surgical robotics in cardiac surgery;
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Renowned interventional cardiologists with deep expertise in the development and clinical use of drug-eluting stent technology, percutaneous valve technologies, and advanced electrophysiology techniques.
Innovative Approaches to Cardiovascular Care
BWH physicians and investigators who provide cardiovascular care attend a weekly conference to discuss new protocols that may become appropriate components of hybrid strategies. BWH is also developing an “operating room of the future” designed to accommodate both interventional and surgical procedures. This OR suite will encompass robotics and other innovative technology of the cardiac operating suite, as well as the sophisticated imaging modalities and other technology critical to the electrophysiology and catheterization laboratories.
“We believe that a carefully selected group of patients, including the elderly and others at high risk, stands to benefit significantly from less traumatic hybrid approaches,” says Dr. Cohn.
This article appeared in BWH's Winter 2005 Cardiovascular Center Update.
The Cardiovascular Center at BWH
Delivering innovative insights and solutions to even the most complex disorders of the heart, vessels and circulatory system, The Cardiovascular Center leads the way in providing comprehensive care across the full spectrum of cardiovascular disease areas. Many of the innovative therapies and state-of-the-art technologies available at the Center have been developed by the experts of Brigham and Women’s Hospital. We are consistently ranked among the best hospitals in the country in just about every specialty, including cardiac surgery, cardiovascular medicine and vascular surgery.
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