title: Hybrid operating room concept for combined diagnostics, intervention and surgery in acute type A dissection.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: Department of Thoracic and Cardiovascular Surgery, West German Heart Centre, University of Duisburg-Essen, Germany. konstantinos.tsagakis@uk-essen.de
authors: Konstantinos
authors: K
authors: Tsagakis
authors: Thomas
authors: T
authors: Konorza
authors: Daniel Sebastian
authors: DS
authors: Dohle
authors: Eva
authors: E
authors: Kottenberg
authors: Thomas
authors: T
authors: Buck
authors: Matthias
authors: M
authors: Thielmann
authors: Raimund
authors: R
authors: Erbel
authors: Heinz
authors: H
authors: Jakob
mesh_terms: D000208:Acute Disease; D000784:Aortic Dissection / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D000792:Angiography / Q000706:statistics & numerical data; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D002545:Brain Ischemia / Q000175:diagnosis / Q000601:surgery; D002305:Cardiac Tamponade / Q000601:surgery; D002560:Cerebrovascular Circulation / Q000502:physiology; D003324:Coronary Artery Disease / Q000503:physiopathology / Q000601:surgery; D042241:Early Diagnosis; D017548:Echocardiography, Transesophageal / Q000706:statistics & numerical data; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D061212:Memory, Episodic; D008875:Middle Aged; D009873:Operating Rooms / Q000458:organization & administration*; D016491:Peripheral Vascular Diseases / Q000175:diagnosis / Q000601:surgery; D011300:Preoperative Care; D012039:Regional Blood Flow / Q000502:physiology; D061665:Time-to-Treatment; D014781:Viscera / Q000098:blood supply