New Hybrid Operating Room Will Expand Surgical Options

In 2016, Darden, Green, Hwang, Newsletter, Raghavan, Schutz, Volume 8 Issue 1 by Addison Clark

RAF to Collaborate with Multidisciplinary Team at Mary Washington Hospital

Many people associate the term “hybrid” with vehicles that have two or more power sources. But the term is also being used to refer to a growing number of high-tech hospital operating rooms (ORs), including a new suite in the making at Mary Washington Hospital (MWH) in Fredericksburg. When the hospital’s hybrid OR opens in third quarter 2016, physicians from Radiologic Associates of Fredericksburg (RAF) will be an integral part of the treatment team.

According to Mr. Mike Brown, Program Manager for Cardiac Surgery and Chief Perfusionist at MWH, the new 1,000+-square-foot procedure room will be located between the current OR and catheterization, or “cath,” lab. “It’s called a ‘hybrid’ room because it marries the critical features of an OR and a cath lab,” he said. “We’ll be able to perform less invasive or minimally invasive procedures that provide better clinical outcomes for certain patient populations. Also, with the advanced technology available in the room, we can perform higher-risk complex procedures.”

Mr. Brown noted that the main advantage of a hybrid OR for patient care is an unparalleled level of collaboration that makes seamless procedures possible. “We can move from the cath lab to the OR setting without having to stop a procedure and move the patient to another area of the hospital. Surgery team members are also participating in the procedures and are on hand should a complication arise and open heart surgery be needed.”

The state-of-the-art addition, which has been carefully planned for some time, will support the minimally invasive surgical technique  known  as  transcatheter  aortic valve replacement, or TAVR, for patients with aortic stenosis. This condition occurs when the aortic valve narrows and obstructs blood flow from the heart into the aorta and the rest of the body, weakening the heart as it works harder to pump blood across the narrowed valve.

“While open heart surgery to replace the valve has been the traditional route for treating aortic stenosis, the risks for some patients outweigh the potential benefits,” Mr. Brown said. “TAVR makes heart valve replacement available to patients who have aortic stenosis but are considered too high risk for traditional open heart surgery.” He noted that most patients who have this procedure are in their 70s, 80s, or 90s and often have other medical conditions that make them better candidates for minimally invasive surgery.

Neil B. Green, MD, a board-certified diagnostic radiologist at RAF, is part of a team of RAF physicians who will provide diagnostic radiology services to the hybrid OR. Other RAF team members include Daryle L. Darden, MD; Edward C. Hwang, MD; Jakob C.L. Schutz, MD; and Deepak Raghavan, MD.

“Based on a preoperative CT scan, RAF physicians will help determine the safest and most precise way to place the new valve,” Dr. Green said. With TAVR, physicians can use a catheter, or tiny tube, to guide an artificial heart valve through an artery in the groin or directly into the heart, position it within the patient’s damaged heart valve, and open it to restore blood flow, he explained.

Patient evaluation for aortic stenosis begins at the MWH Heart Valve Clinic. RAF diagnostic radiologists are part of the hospital’s Structural Heart Team, which also includes referring cardiologists, interventional cardiologists, cardiac surgeons, anesthesiologists and other health care professionals. They work together with the Valve Clinic on patient selection and appropriate treatment plans. Patients are screened for TAVR in collaboration with their referring cardiologist or primary care physician.

According to Dr. Green, because TAVR is less invasive, it typically has a lower risk of complications, a shorter recovery time, and a faster return to normal life than open heart surgery. Post-TAVR hospitalization is typically three to five days, he noted, in contrast to two to three months for open heart surgery.

Although the MWH hybrid OR will not open until later this year, the now fully operational MWH Heart Valve Clinic is using Virginia Commonwealth University (VCU) Medical Center’s hybrid OR temporarily during the construction to treat Fredericksburg community patients in need of a new valve. Two MWH physicians, John Cardone, MD, a cardiothoracic surgeon, and Rajiv Tayal, MD, an interventional cardiologist, have been working with VCU Medical Center in Richmond to make this treatment option available to qualified patients from the Fredericksburg area.

Ms. Deb Renfro, RN, who serves as nurse manager of the MWH cath lab, said the hybrid OR will include multiple advanced devices and technologies from a variety of vendors. “We partnered with our physicians to select the equipment that will best accommodate their patients’ needs and create a truly multidisciplinary environment,” Ms. Renfro said. The imaging devices include a large monitor attached to the ceiling, which enables three-dimensional imaging that can rotate around the patient during a procedure, completing a CT scan in real time.

“By bringing together the latest imaging modalities and traditional surgical capabilities, our patients can receive the most advanced care while our clinicians have more flexibility to tailor procedures to individual patients,” Ms. Renfro noted. “We believe this is the future of patient-centered surgery.


Pictured above is Dr. Neil Green (left) and Dr. Edward Hwang are part of the RAF team that will provide diagnostic radiology services to the hybrid OR.