In June 2004, the quest to meet these challenges led to CCH™s development of the nation™s first fully-equipped therapeutic cardiac suites for hybrid therapy, designed to meet the special needs of newborns, adolescents and adults with congenital heart disease. The new Hybrid Cardiac Catheterization Suites allow interventionalists and surgeons to collaboratively perform a wide range of innovative combined transcatheter and surgical (hybrid) procedures, including treatment of hypoplastic left heart syndrome, intraoperative stent implantation, and perventricular closure of ventricular septal defects using closure devices.

Each of the two suites features more than 900 square feet of working space and can accommodate the entire Hybrid Team, including interventional cardiologists, surgeons, cardiac anesthesiologists, perfusionists and echocardiographers, along with the necessary clinical and technical support staff and their equipment.

Working jointly with Toshiba America Medical Systems, CCH equipped each suite with the latest in cardiac bi-plane x-ray technology available at the time, the Infinix CB-i/BP vascular x-ray system. In addition, we partnered with Stryker Communications to furnish each suite with six strategically-placed flat-panel video monitors. The monitors are attached to three ceiling-mounted booms to ensure that at least two can be seen by any staff member at all times, regardless of an individual™s location within the suite. In addition, two pan, tilt-zoom video cameras are mounted both on the wall and on one of the booms to provide imaging from any location. The total cost of the two suites was approximately $8 million. Following the completion of the hybrid catheterization suites, engineers from Toshiba routinely visited the center to ensure the systems were operating as expected and to provide support where needed.

We had partnered with Toshiba in the past as well. As somewhat of a physician engineer, I had been invited by Toshiba Medical System Corporation (Nasu, Japan) to work with product development engineers on a new project designing and developing the first five-axis positioner aimed at permitting unrestricted patient access from virtually any angle. The system we envisioned would allow fingertip-to-fingertip and head-to-toe coverage for cardiac imaging and would include a new bi-plane imaging system using flat panel detector (FPD) technology.

For years, we worked on possible designs and imaging standards with the engineers in Japan in an effort to relay to Toshiba™s product design team exactly what CCH envisioned. In addition, to ensure that the new design also met the needs of interventional catheterization and cardiothoracic surgery, Mark E. Galantowicz, MD, Chief of Cardiothoracic Surgery, accompanied me to Japan to illustrate the surgical needs of a hybrid suite and the equipment. Using actual cardiac catheterization and surgery film footage, we demonstrated to Toshiba™s product development team how the current equipment is used, and helped them assess what modifications and improvements were needed for maximum effectiveness.

In July 2005, our collaboration was complete and CCH became home to the first cardiac bi-plane imaging system featuring a five-axis positioner and bi-plane flat panel detectors the Toshiba Infinix CF-i/BP. Installed in our Heart Center™s Hybrid Suite No. 1 as a prototype, we became the first in the world to use this new technology. The system enables us to obtain bi-plane views of any region of the heart with a unique C-arm design that provides unparalleled access to the patient. In addition, the new equipment features 8-inch cardiac FPDs delivering outstanding, distortion-free images.

The hybrid approach has allowed us to develop new management strategies and reduce the amount of time we need to correct complex disorders of the heart. In addition, patient outcomes have improved due to shorter and safer procedures that require less recovery and rehabilitation time decreasing the emotional and physical stress placed on a patient and their family.

As a result of overwhelmingly positive patient outcomes using hybrid strategies and the five-axis positioner and FPD technology, we initiated installation of the world™s first production model of the Infinix CF-i/BP in Hybrid Suite No. 2. In addition, ongoing collaboration with technology developers like Toshiba continues to reinforce our philosophy of providing cutting-edge treatment and technology. We are currently working with Toshiba to design a new hybrid procedure table that will be fluoroscopic-friendly, yet allow movement and positions necessary to treat complex CHD using combined surgical techniques.

In addition to improvements in patient care, we have realized many other benefits using the hybrid suites, including the real-time availability of information to team members during procedures. Using state-of-the-art video routers supplied by Stryker and located in each suite, we now have access to angiograms, echocardiograms, physiology monitoring, CT and MRI scans, and many other imaging or patient data that can be displayed throughout the entire procedure. This allows unique teaching opportunities for our guests that travel from both within and outside of the United States, such as recent guests who traveled all the way from China (Figure 1).

One of our dreams when developing the hybrid suites was to have a remote telemedicine system that would allow us to transfer patient information and images to physicians in any number of locations for immediate response and feedback whether they are in a different area of The Heart Center, another state, or on the other side of the world. Today, that dream is a reality. The unique environment of our hybrid suites stretches beyond physicians here in Columbus with the completion of our TeleMedicine Center. The TeleMedicine Center allows us to include referring physicians and teach the unique procedures remotely in real-time, while we frequently perform live case demonstrations from our suites to teaching conferences in Chicago, Orlando, Frankfurt, Beijing, and other locations worldwide.

Our primary hope is that our TeleMedicine Center will make it easy for clinicians to learn about our new approach and impart that knowledge to their colleagues and ultimately their patients. As such, Columbus Children™s Hospital and Columbus Children™s Research Institute will host the inaugural International Symposium for the Hybrid Approach to Congenital Heart Disease (ISHAC) on June 28-30, 2006. We welcome you to come and visit our Hybrid Cardiac Catheterization Suites and learn more about new hybrid therapies for complex CHD.