chapter  3
10 Pages

How to build a hybrid congenital heart disease program

WithJohn P Cheatham

The advances in surgical therapy for congenital heart disease (CHD) have mirrored the progress in transcatheter techniques and materials, especially in the past two decades.Yet the disciplines of cardiothoracic surgery and interventional cardiology have taken decidedly different paths for success. In the world of acquired heart disease, adult cardiologists and surgeons frequently have been at odds, or competitive, in their quest to treat coronary artery disease. However, a ‘team approach’ has always been required to build a successful program dedicated to CHD. It takes a cooperative spirit between multiple specialists, such as cardiologists, surgeons, anesthesiologists, intensivists, nurses, and technicians, to treat infants, children, and adults with complex CHD. None-the-less, surgical management strategies have differed from transcatheter options – similar to our adult colleagues. Sometimes, the challenges and obstacles confronting

the CHD surgeon in the operative theater mirror the barriers facing the CHD interventional cardiologist for success in the cardiac catheterization laboratory. As time has passed, it has become more obvious to both specialists that, if they combine their talents, they may in fact eliminate some of these obstacles and improve outcomes. So, we have coined the term Hybrid Therapy to signify this new spirit of collaboration. According to Webster’s, Revised Unabridged Dictionary, 1996, the definition of Hybrid \Hy”brid\, n. [L. hybrida, hibrida, (Biol.)] is the offspring of the union of two distinct species; an animal or plant produced from the mixture of two species. Some would argue that the cardiothoracic surgeon and the interventional cardiologist are definitely two different species – different training, different manners, different expectations, and definitely different salaries! However, those differences continue to disappear as the disciplines come closer and closer together and new management strategies emerge. So, exactly what is a Hybrid approach? First, it starts

with a collaborative effort between the cardiothoracic surgeon and interventional cardiologist. It continues with careful planning of a management strategy involving the other services withinThe Heart Center – namely, the other cardiologists, anesthesiologists, intensive care team, nurses, perfusionists, and even outside services

such as neonatology and radiology.This type of approach encourages the sharing of ideas, expertise, equipment, and techniques. It allows one to think ‘outside the box’ and to develop novel treatment strategies. We have coined the term Two Perspectives. Single Focus. to represent the spirit of the Hybrid approach. The goals ofHybrid therapy aremany: (1) to reduce both

morbidity and mortality, (2) to reduce the cumulative impact of multiple interventions often required to treat those with complexCHD,(3) to improve the quality of life, (4) to deliver more efficient and cost-effective care, and (5) to encourage teamwork. However, there are a few requirements for initiating a successful Hybrid program. First and foremost, there can be no competition between the surgeon and interventionalist, economically or professionally! There must be mutual respect for each other and the talents and limitations that each possess. It is important that no individual’s opinion is weighted more than the other – it is a partnership. All members of The Heart Center team must also be supportive of this new concept, for someone must refer the patients for treatment, someone must care for them while recovering in the CICU (cardiac intensive care unit) and ward, and someone must closely follow the patients in the outpatient clinic to assess the outcome.