Multidisciplinary care and lastest technologies are utilized in hybrid therapies at BWH
Brigham and Women’s Hospital (BWH) cardiovascular specialists have been national leaders in the clinical development of an integrated, multidisciplinary approach to treating cardiovascular disease and so-called hybrid therapies – a combination of percutaneous interventions plus conventional or minimally invasive surgical procedures.
According to R. Morton Bolman, MD, BWH Chief of Cardiac Surgery, “Historically, most cardiovascular disease has been treated in silos defined by specialty expertise. As less invasive procedures have been perfected, hybrid therapies predicated on an interdisciplinary approach to care defined by the patient’s needs – have emerged as safe, effective, and durable treatment alternatives for selected patients. Our Cardiovascular Center’s focus on integrated care through multispecialty collaboration provides an ideal enviroment in which to realize the full therapeutic value of hybrid procedures.”
Revascularization and valve surgery
The most commonly performed hybrid procedure at BWH is percutaneous revascularization followed by same-day conventional or minimally invasive valve repair or replacement. Within a few years, catheter-based techniques for valve repair, currently under investigation at BWH and other centers, are expected to receive FDA approval, making a still-less invasive procedure possible for selected patients with narrowing in the coronary arteries as well as valvular disease.
Less invasive thoracic aortic repair
Another promising therapy is endovascular treatment of thoracic aortic aneurysms. An endograft consisting of a fabric-covered wire mesh conduit is deployed percutaneously to exclude from circulation the weakened area of the aorta. Endovascular aortic repair allows appropriately selected patients to avoid complex surgery to replace a major vessel. This less invasive repair can potentially be used in concert with other minimally invasive cardiac procedures.
Additions to the hybrid armamentarium
In the near future, combinations of innovative techniques including percutaneous ablation of cardiac arrhythmias, valve repair, robotic approaches to cardiac repair, and robotic placement of biventricular pacing leads are expected to make significant contributions to the hybrid armamentarium.
Patient selection
Because hybrid procedures are generally shorter and less invasive than their conventional counterparts, they are ideally suited for the treatment of older, more fragile patients who may be at elevated risk for conventional surgery. However, increasingly, a selected group of younger, sturdier patients – typically those with single vessel blockage and valve disease – may be good candidates for hybrid procedures.
Training the practitioners of the future
In July, Michael J. Davidson, MD, joined BWH’s cardiac surgery team as the first fellowship-trained surgeon to receive training in hybrid cardiovascular therapies. This hybrid fellowship was specially designed in collaboration with the Center for Integration of Medicine and Innovative Technology (CIMIT). CIMIT is a clinically-centered consortium, including Partners HealthCare and Massachusetts Institute of Technology, that draws on the strengths of various clinicians, inventors, engineers and others to bridge between concept and reality. The fellowship is one of only a handful of similar training opportunities in the United States. Dr. Davidson will work collaboratively with specialists from vascular surgery, cardiology, and interventional radiology to develop endovascular approaches to treating thoracic aortic pathology and valvular heart disease.
Also in July, BWH cardiac surgery fellows began learning basic catheterization skills and cardiology fellows will spend time in the operating room and the cardiac ICU. Dr. Bolman says “We believe this cross-training will promote communication across traditional disciplines, interdisciplinary collaboration, and the development of novel approaches to cardiovascular care.”
The OR of the future will be here soon
A hybrid procedures suite in BWH’s new Carl J. and Ruth Shapiro Cardiovascular Center building, slated to open in 2008, will further enhance physicians’ ability to provide hybrid therapies. The new suite will accommodate surgical robotics and other innovations of the cardiac operating room as well sophisticated imaging and other advanced technology of the electrophysiology and catheterization laboratories. Thus patients can receive all necessary therapies in the same suite, on the same day, without having to move from room to room. Dr. Bolman concludes, “Hybrid therapies are the result of a new way of thinking about the best way to provide cardiovascular interventions whether they are surgical or percutaneous – centered on each patient’s needs, and a willingness to combine these approaches in novel ways to benefit our patients. Hybrid therapies enable us as clinicians to bring our best talents and expertise to provide the safest, most effective, and least invasive care.”
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