MDNews - Greater Kansas

Administration (FDA) approved a transfemoral procedure that delivers the Edwards SAPIEN Transcatheter Heart Valve in the same manner as a common heart catheterization procedure. This allows inoperable patients to be treated in a way that doesn't require open-chest surgery. In October 2012, the FDA approved another deliver y method for the Edwards SAPIEN valve called the transapical procedure, which is indicated for patients who don't have suitable access through their leg artery. In this procedure, the replacement valve is inserted through an incision between the ribs and through the bottom end of the heart. These procedures require the highestquality technology for success. The Methodist DeBakey Cardiovascular Journal reports that space consideration is critical to the success of the procedure and that a transcatheter aortic valve replacement (TAVR) program requires a commitment and investment by a medical facility. That includes proper outfitting of an appropriate procedure room, typically a "hybrid" operating room, which includes the highestquality radiology equipment. Via Christi makes Commitment In early 2012, community physicians in Wichita approached the administration at Via Christi to explore the potential of adding a hybrid operating room at Via Christi Hospital St. Francis, which would allow for the development of a TAVR program. "The addition of a hybrid OR at St. Francis was a physician-requested endeavor, and the administration at Via Christi quickly followed through with our request," says Brett Grizzell, MD, a cardiothoracic surgeon with Wichita Surgical Specialists who has a special interest in TAVR procedures. "They held community meetings and listened to input throughout the process, including building a mock-up of the hybrid room, which allowed changes recommended by physicians to be made on the spot." Bassem Chehab, MD, a structural Sinisa Malinovic, MD, (left) and David Havey, MD, are anesthesiologists who will be part of the hybrid OR surgical team at St. Francis. inter ventiona l ca rdiologist w ith Cardiovascular Consultants of Kansas and Medical Director for the structural heart valve and hybrid OR programs at Via Christi, says, "It was a tremendous effort and it was financed by the hospital, but it was really a community effort." The work with physicians in developing the hybrid OR was not limited to cardiology or vascular specialists, says Sinisa Malinovic, MD, anesthesiologist with Anesthesia Consulting Services. "Many different specialists were involved in helping define the direction for the hybrid OR," says Dr. Malinovic, who received his medical degree from the University of Banja Luka in Bosnia and Herzegovina and completed his residency in anesthesiology at the University of Kansas School of Medicine. "You should always involve physicians in determining what's best for patients. Via Christi has always been supportive of the multidisciplinary approach to medicine and willing to listen to what's best for the patient." Those specialists included interventional radiologists as well as cardiovascular surgeons and anesthesiologists, says Sanjay Khicha, MD, a cardiothoracic surgeon with Wichita Surgical Specialists who received his medical degree from Tulane University School of Medicine and completed his fellowship at Ochsner Foundation Hospital in New Orleans. Hybrid OR for more Than TAVR "It's called the hybrid OR, not the TAVR suite," says Dr. Chehab, who received his medical degree from the Lebanese University Faculty of Medical Sciences and completed his fellowship in interventional cardiology and cardiovascular medicine at the University of Kansas Medical Center in Kansas City. "It's really a versatile room. It can offer the patient multiple options." The hybrid OR is the standard of care for thoracic aortic and abdominal aortic stent grafting, especially from a peripheral vascular perspective, says Jason Woolard, MD, FACS, who received his medical degree from the University of Kansas School of Medicine and completed a fellowship in vascular surgery at Baylor University Medical Center in Dallas. In addition, he says, because the suite at St. Francis was so well designed and executed, open procedures can be performed there as well as minimally invasive procedures. The radiology technology in the suite is far superior to a traditional C-arm, and its clarity is vastly superior to traditional radiology. The OR also offers 3-D reconstruction imaging. "The radiology technology in the hybrid OR will be attractive to many other specialties," says Dr. Malinovic. "It lets physicians offer the most advanced care with its high-tech equipment." Because of its attractiveness to other mDNEWS.COm ■ MD News Greater Kansas |7

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