Umakanthan Ramanan, Leacche Marzia, Petracek Michael R, Zhao David X, Byrne John G
Vanderbilt University Medical Center, Department of Cardiac Surgery, 1215 21st Avenue South, Nashville, TN 37232, USA.
Curr Treat Options Cardiovasc Med. 2009 Dec;11(6):492-8. doi: 10.1007/s11936-009-0052-2.
Combined coronary artery valvular heart disease is a major cause of morbidity and mortality in the adult patient population. The standard treatment for such disease has been open heart surgery in which coronary artery bypass grafting (CABG) is performed concurrently with valve surgery using a median sternotomy and cardiopulmonary bypass. With the increasing complexity of patients referred to surgery, some patients may prove to be poor surgical candidates for combined valve and CABG surgery. In certain selected patients who fall into this category, valve surgery and percutaneous coronary intervention (PCI) have been considered a feasible alternative. Conventionally, valve surgery is performed in the cardiac surgical operating room, whereas PCI is carried out in the cardiac catheterization laboratory. Separation of these two procedural suites has presented a logistic limitation because it impedes the concomitant performance of both procedures in one setting. Hence, PCI and valve surgery usually have been performed as a "two-stage" procedure in two different operative suites, with the procedures being separated by hours, days, or weeks. Technologic advancements have made possible the construction of a "hybrid" procedural suite that combines the facilities of a cardiac surgical operating room with those of a cardiac catheterization laboratory. This design has enabled the concept of "one-stage" or "one-stop" PCI and valve surgery, allowing both procedures to be performed in a hybrid suite in one setting, separated by minutes. The advantages of such a method could prove to be multifold by enabling a less invasive surgical approach and improving logistics, patient satisfaction, and outcomes in selected patients.
冠状动脉瓣膜性心脏病是成年患者发病和死亡的主要原因。此类疾病的标准治疗方法一直是心脏直视手术，即采用正中胸骨切开术和体外循环，在进行瓣膜手术的同时进行冠状动脉旁路移植术（CABG）。随着接受手术治疗的患者病情日益复杂，一些患者可能被证明不适合进行瓣膜和CABG联合手术。在某些属于这一类别的特定患者中，瓣膜手术和经皮冠状动脉介入治疗（PCI）被认为是一种可行的替代方案。传统上，瓣膜手术在心脏外科手术室进行，而PCI在心脏导管实验室进行。这两个手术区域的分离带来了后勤方面的限制，因为它阻碍了在同一环境中同时进行这两种手术。因此，PCI和瓣膜手术通常在两个不同的手术区域作为“两阶段”手术进行，手术之间间隔数小时、数天或数周。技术进步使得构建一个“杂交”手术区域成为可能，该区域将心脏外科手术室的设施与心脏导管实验室的设施结合在一起。这种设计实现了“一站式”或“一站式”PCI和瓣膜手术的概念，使这两种手术能够在一个杂交手术区域内一次完成，间隔仅几分钟。这种方法的优点可能是多方面的，它能够采用侵入性较小的手术方法，并改善后勤保障、患者满意度以及特定患者的治疗效果。
