A New Approach to Heart Bypass Surgery Provides Patients with 'One-stop Shopping'

Vanderbilt University Medical Center has become the first hospital in the region to offer a novel approach to cardiac surgery which doctors believe will change the standard of care for cardiovascular patients.

Called the Hybrid OR/Cath Lab, the state-of-the-art operating suite houses all the equipment and monitoring devices necessary to perform open-heart surgeries, like coronary bypass, as well as percutaneous coronary interventions and procedures, including angioplasty and stenting.

A major advantage will be the ability to perform an angiogram at the end of routine cardiac surgical cases to make sure grafts are in place and blood is flowing properly. Traditionally, a "before picture" was obtained prior to surgery, but an X-ray study after procedures are completed was not the standard of care.

John Byrne, M.D., likens the Hybrid OR to the change seen in the auto industry after the introduction of safety features like seatbelts and airbags.

"We wear our seat belts every day and have air bags. How often does an air bag deploy? Maybe once or twice in your life. I for one am glad it's there when and if it does deploy. The Hybrid OR/CathLab will catch the rare but very important technical error (if it arises). Just like seat belts and air bags save your life in a car accident."

Byrne, The William S. Stoney Jr. Professor of Cardiac Surgery and Chair of the Department, said most people had no idea that X-rays of cardiac surgical procedures were not performed post-surgery. He refers to the new operating environment as "sighted" cardiac surgery.

"In virtually every reconstructive procedure in medicine and surgery, the medical team takes a "before" and "after" picture," said Byrne. "When we put in a central line, nasogastric tube, a chest tube or an endotracheal tube, when your knee or hip is operated on, when you have gall bladder surgery, you get a before and after picture. When you have your heart valve operated on you have a before and after picture (intraoperative echocardiography).

"But for coronary artery surgery there is no "after" picture," he said. "Placing the left internal mammary artery to the left anterior descending coronary artery is perhaps the most important reconstructive procedure any human will ever have in their entire life, yet we don't image the quality of the result. We don't measure it. We've never measured it. This has all changed at Vanderbilt."

Although Vanderbilt is one of six centers nationally exploring this idea, it is believed to be the first to put the concept to use.

On April 4, the first patient to undergo the newest technology was Robert Metry, a 66-year-old health care attorney from Franklin.

Metry was not hesitant to become a pioneer. His triple bypass surgery was done in the new operating suite.

"The first thing that interested me was the pure science of having the image done in real time," he said. "They knew that everything was OK when they closed me up. I was also excited that I was getting the A-team."