Hybrid OR – A High Level View

Over the last 12 to 18 months MD Buyline has seen a steady increase in the number of interventional x-ray imaging system quotes, which have been identified as and configured for what has been widely referred to as “hybrid OR rooms.”   In the most simple of terms, a hybrid OR room consists of a cardiac and/or vascular angiography imaging system, configured with a table that can be oriented to enhance the field of view as well as improve access to patients if the procedure needs to be converted from a catheter-based interventional case to an open surgical case.

The increase in interest might be attributed to the evolution of aortic valve (AOV) replacement that can be delivered, positioned, and deployed via a catheter rather than an open-heart surgical case, Trans-catheter Aortic Valve Replacement or Implantation (TAVR/TAVI).  This has opened up a medical treatment to patients with diseased aortic valves who, for a variety of reasons, are not acceptable surgical candidates.    FDA guidelines and limitations, along with available valve technology, limit the number of candidates for this approach, but as new device approvals come from the FDA and guidelines broaden from the CMS,  the general consensus is that this will become a more widely used approach to aortic valvular disease.    Advancements in other valvular disease treatment, as well as new techniques in some electrophysiology interventional approaches, are also contributing factors to this growth segment.

From a technology perspective, Hybrid OR equipment consists of the following: (The items noted with an asterisk are required. All other items are preferable but not required.)

  • *Cardiac or Vascular X-ray
  • Specialized Radiographic imaging/surgical or specialized surgical/imaging table
  • Large Multi-functional Monitors (56”)
  • *Hemodynamic Monitoring
  • *Image Capture/Storage System (PACS)
  • Cardiovascular Information System (CVIS/CIS)
  • *Transesophageal Echocardiography
  • Intra-cardiac Echocardiography (ICE)
  • Integrated or stand-alone software program to assist in valve positioning and      orientation
  • *Intra-aortic Balloon Pump or other ventricular support technology
  • *Anesthesiology System
  • *Heart-Lung Bypass System
  • *Cardiac Defibrillator
  • *Surgical / OR lighting
  • *Radiographic Imaging Shields

Depending on location (Cath lab or Surgery), the room requirements may differ.    Thus, a multi-functional team for both cardiology as well as surgery is required in order for a program to be successful.   Also, there are a variety of issues that must be considered before setting up a program of this type. Some of these issues are charge capture, billing, inventory management, staffing, location, and logistics of the room.

The Hybrid OR room seems to be a hot topic, however creating and building one requires a very significant commitment on the part of the facility, the staff, and the physicians involved.   It requires a very highly skilled and trained group of physicians and clinicians to even consider starting a program like this.  It is not a program to jump into without a fair amount of planning so that all of the pieces necessary to implement, grow, and support the program will result in high-quality care to a very challenging and sick segment of the population.

Watch for a more on this topic from MD Buyline related to the market, technology, and key insight from physicians and program coordinators who already actively support these programs.   Hear what they have learned, what they would do differently, and what their advice is to all who are considering starting a program of their own.

Tom Watson, BS, RCVT
Tom Watson, BS, RCVT, Clinical Analyst — Mr. Watson joined MD Buyline in 1986 and has over 40 years of experience in the field of cardiovascular medicine. At MD Buyline, Mr. Watson's primary responsibility is invasive cardiovascular technology - interventional angiography, electrophysiology imaging and monitoring, cardiology PACS and information systems and a number of other areas. He graduated with a Bachelor of Science degree from Louisiana State University. He received registries in both noninvasive and invasive cardiovascular modalities through the National Society of Cardiopulmonary Technologies, as well as adult echocardiography through the American Registry of Diagnostic Medical Sonographers.