Reinventing the Cardiac Cath Lab

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Hybrid catheterization suite at Columbus Children's HospitalThe cardiac catheterization lab is evolving. Just a few years ago, diagnostic cardiac catheterization was the procedure of choice for patients with equivocal or abnormal stress tests, and the other mainstay of the cath lab — interventional procedures could require a week-long hospital stay. But today’s state-of-the-art cath labs differ from their predecessors.

The hallmarks of the cath lab of the future are flexibility and efficiency. Procedures are changing. The advent of 64-slice CT and CT angiography (CTA) makes it possible to bypass diagnostic catheterization in many cases. But electrophysiology (EP) procedures are on the rise. Take for example Houston’s Methodist-DeBakey Cardiac Cath Lab at The Methodist Hospital. Three years ago, EP accounted for 15 percent of cath lab business. Today, 40 percent of cath lab volume stems from EP procedures. At the same time, increases in peripheral vascular work, and the advent of hybrid catheterization/cardiac surgical suites are re-inventing the cardiac cath lab.

As sites across the country retrofit or construct new cath labs, it’s important to design for current and future procedure load and volume. Consequently, many facilities opt for a mix of digital flat-panel imaging equipment to better meet the needs of a wider assortment of procedures. Take for example North Shore University Hospital in Manhasset, N.Y. The cardiac cath labs are equipped with an assortment of GE Healthcare Innova x-ray systems. Innova 2100, a 20 x 20 cm flat-panel system and Innova 3100, a 31 cm square system, serve as the primary cardiac x-ray systems and can be used for carotid and renal imaging as well, says Stephen Green, MD, associate director of cardiac catheterization lab. The hospital’s largest system, Innova 4100 is excellent for peripheral vascular work. If peripheral vascular volume is high, one or more of the hospital’s three Innova 3100 systems can accommodate peripheral vascular cases.
While digital flat panel x-ray systems are the core of the cath lab, other components like hemodynamic monitoring systems, reporting and archiving solutions also contribute to streamlined operations. 

This month, Inside Cardiac Imaging visits with several sites on the leading edge of cardiac cath lab imaging to learn about the benefits and challenges associated with outfitting a new lab.

Inside the hybrid cardiac catheterization suite

The Heart Center at Columbus Children’s Hospital in Columbus, Ohio, is a comprehensive cardiac center designed to meet the needs of pediatric and adult patients with congenital heart disease. The center is committed to state-of-the-art patient care and a minimally invasive approach to diagnosis and treatment of congenital heart disease.

Several years ago, John P. Cheatham, MD, director of cardiac catheterization and interventional therapy, and his colleagues realized that optimal treatment for many patients required a multidisciplinary approach that combines surgical and cardiac cath skills. An all-too-common conundrum in treating complex congenital heart disease is that surgeons can’t fix what they can’t see; at the same time cardiologists can not access every defect via a conventionally-placed catheter. The interdisciplinary “hybrid” approach blends cardiac catheterization and cardiac surgery to provide patients with the best of both specialties.

“Take [for example] the child with narrowing of the arteries that feed into the lungs. The arteries could be behind the aorta or inside the lung. It’s difficult for the surgeon to visualize the defect from the outside. At the same time, in selected patients it’s also difficult to access the defect via a conventional catheter,” explains Cheatham. Image-guided surgery, however, can provide access to the defect.

The hybrid approach; however, requires a different type of configuration. A typical cardiac OR suite is not x-ray or cath friendly as it lacks specialized imaging equipment. Metal OR tables compound the problem. On the other hand, a traditional cath lab is often too small for surgery and lacks operative lights, proper sterile environment and other surgical essentials.

The Heart Center solved the conundrum by building the world’s first two hybrid cardiac catheterization suites dedicated to treating complex congenital heart disease. The cornerstone of the new suites is Toshiba America Medical Systems Infinix CF-i/BP system. The Infinix system offers five-axis bi-plane x-ray imaging technology with flat-panel detectors.