Department of Thoracic and Cardiovascular Surgery, West German Heart Centre, University of Duisburg-Essen, Germany.
Eur J Cardiothorac Surg. 2013 Feb;43(2):397-404. doi: 10.1093/ejcts/ezs287. Epub 2012 Jun 27.
In acute type A dissection (AAAD), it is commonly decided to carry out immediate surgical repair without invasive diagnostics. The hybrid operating room (Hybrid OR) concept encompasses simultaneous haemodynamic control, non-invasive and invasive diagnostics and immediate surgical and/or interventional treatment. Results over a seven-year period are presented here.
From March 2004 to March 2011, 1883 cardiological and surgical patients were treated in a Hybrid OR. Of these, 124 patients (age 60 ± 13, 64% male) diagnosed with AAAD were operated upon. External computed tomography (CT) was available for 87% (108/124) of cases and angiography in 15% (19/124). Preoperative transoesophageal echocardiography (TEE) was done in all patients and angiography in 57% (71/124). Surgery was performed without angiography in 27% (34/124), of which 14% (17/124) was due to shock. Postoperative control angiography followed in 18% (22/124) due to suspected ongoing malperfusion.
Preoperative angiography was performed in 71 patients, and no angiography related complications were observed during the procedure. A total of 32% (23/71) of these underwent coronary artery bypass graft (CABG)--for newly-diagnosed coronary artery disease in 21% of cases and for coronary malperfusion in 11%. Visceral/peripheral malperfusion syndromes, necessitating primary endovascular intervention, were detected in 23% (16/71). Ascending aorta replacement was performed in 100% (124/124) of patients, arch replacement in 88% (109/124) and descending aorta repair in 35% (44/124). Five postoperative endovascular interventions became necessary due to persistent malperfusion. In-hospital mortality was 13% (12/90) in patients who had undergone preoperative invasive diagnostics and 24% (8/34) in patients who had not.
The Hybrid OR concept enables the exact diagnosis of coronary status and downstream malperfusion sites and influences the design of surgical and/or endovascular treatment, without time delay and at negligible risk to the patient.
在急性 A 型夹层（AAAD）中，通常决定不进行有创诊断而立即进行手术修复。杂交手术室（Hybrid OR）概念包含同时进行血液动力学控制、无创和有创诊断以及立即进行手术和/或介入治疗。本文呈现了七年期间的结果。
从 2004 年 3 月至 2011 年 3 月，1883 例心血管和外科患者在 Hybrid OR 中接受治疗。其中，124 例（年龄 60 ± 13 岁，64%为男性）诊断为 AAAD 的患者接受了手术。87%（108/124）的病例可进行外部计算机断层扫描（CT）检查，15%（19/124）的病例可进行血管造影检查。所有患者均进行术前经食管超声心动图（TEE）检查，57%（71/124）的患者进行血管造影检查。27%（34/124）的患者未进行血管造影检查，其中 14%（17/124）的患者因休克而未进行血管造影检查。由于怀疑持续灌注不良，18%（22/124）的患者在术后进行了控制性血管造影检查。
71 例患者进行了术前血管造影检查，术中未观察到与血管造影相关的并发症。其中 32%（23/71）的患者进行了冠状动脉旁路移植术（CABG），其中 21%的患者是由于新诊断的冠状动脉疾病，11%的患者是由于冠状动脉灌注不良。23%（16/71）的患者检测到内脏/外周灌注不良综合征，需要立即进行血管内介入治疗。100%（124/124）的患者进行了升主动脉置换术，88%（109/124）的患者进行了弓部置换术，35%（44/124）的患者进行了降主动脉修复术。由于持续灌注不良，有 5 例患者需要术后进行血管内介入治疗。术前有创诊断组的院内死亡率为 13%（12/90），无术前有创诊断组的院内死亡率为 24%（8/34）。
Hybrid OR 概念能够准确诊断冠状动脉状况和下游灌注不良部位，并影响手术和/或血管内治疗的设计，且不会延误时间，对患者的风险极小。
