1. One-stop Hybrid Cardiac Surgery
from Competition to Integration
Sheng-shou Hu
Department of Cardiac Surgery
Fu Wai Hospital
* This study was supported by the National Tenth-Five Project from the Ministry of Science &Technology

2. 2. Catheter-based Device: the Tools for cardiac surgeon
Stent
Ballon
Occluder
New Valve Prosthesis
Much More …

3. 2.1 VSTENT: A Device for Direct Left Ventricle-to-Coronary Artery Bypass

4. 2.2 Coapsys: a novel off-pump annuloplasty for ischemic mitral regugitation

5. 2.3 Expandable Valve: a novel prosthesis may attack the conventional valve surgery
Transcathter aortic valve implantation and pulmonary insertion have become the reality
Clinical trial of direct implantation of the expandable aortic valve on-pump are going
Implantation of the mitral valve off-pump was feasible in a swine model

6. 3. Real-Time Image Techniques
Guide the operation
Check the results
Including: Echocardiograpy, MRI, Angiogram …
the way forward:
interventional/surgical super-specialist

7. Use of the intra-cardiac & intra-vascular ultrasonic to
direct implant the aortic valve via trans-apical approach
Huber et al. JACC 2005

8. closure of multiple muscular ventricular septal defects
guided by multiple image techniques
Diab et al. J Thorac Cardiovasc Surg,2005

9. 4 Preliminary Experience of One-stop Hybrid Cardiac Surgery in Fu Wai Hospital
Diagnosis No.
PAA/IVS
Severe PS
CHD/abnormal origin PA
CHD/ASD
ASD
Multiple Muscular VSD
Time: Mar.-Oct. 2005
N= 20
Hospital Mortality: 0%
Age Distribution: 1d-68y

10. Tri-part right ventricle exist No subvalvular muscle stenosis
Hybrid procedure for the neonatal management of pulmonary atresia with intact ventricular septum
Operation time: 1d-5d
N= 3, Weight= 4 Kg
Indications:
Tricuspid Valve Z valve < -1
Tri-part right ventricle exist
No subvalvular muscle stenosis
ligation of PDA
Trans-ventricle Perforation & Balloon Valvuloplasty

11. (m) (mmHg) No. Follow-up ΔP PV-regurgitation TV-regurgitation SpO2
Moderate Mild %
Mild-Moderate Mild- Moderate %
Mild-Moderate Mild- Moderate % .

12. ASD
Trans-atrial occlusion
using a sub-axillary mini-incision
Check the released device
Release the device
Indications for Hybrid ASD Repair:
Large ASD in infants
ASD with PAPVC
Some large ASD have poor rim

13. 99±22 24±9 Hybrid Procedures for Multi-VSD On-pump techniques
Regular Repair for the membranous VSD
Trans- atrial Occlude the apical muscular VSD
Results: No Residual Lesions was detected when discharge
Hybrid Procedures for infant severe PS
Off-pump techniques
Trans- ventricle balloon Valvuloplasty
Indications: severe PS in infants
no sub-valvular muscular stenosis
Results:
ΔP(pre-op) ΔP(post-op)
mmHg mmHg
99± ±9
P=0.001

14. Pitfalls of Current One-stop Hybrid Procedures
a truly Hybrid OR
the conventional devices
should be modified
the learning curve
the medical cost

15. SUMMARY the One-stop Hybrid Cardiac Surgery
A Mixture of Therapies out of Different Subspecialties
A Combination Between Surgical and Catheter Based Intervention
still need further clinical investigation
It has great Potential
Future Applications for
the Cardiac Surgery

16. THANK YOU