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Kategorie:
14 Imaging Techniques
Titel:
The use of new generation mobile C-arms for major diagnostic and therapeutic procedures in cardiac surgery. An alternative to the hybrid room?
Autor(en):
Bonaros N.1, Friedrich G.2, Bartel T.2, Müller S.2, Weidinger F.1, Wiedemann D.1, Müller L.1, Grimm M.1, Schachner T.1
Institut(e):
1Innsbruck Medical University, Cardiac Surgery, Innsbruck, Austria, 2Innsbruck Medical University, Cardiology, Innsbruck, Austria
Text:
Objective. The need for a hybrid operation room rises proportionally to the numbers of transcatheter valve implantation, hybrid coronary revascularization and hybrid treatment of aortic diseases. As for many European centers such an investment remains unaffordable, alternative strategies to perform such procedures become indispensable. The aim of the study was to evaluate the use of different advanced mobile c-arms in the cardiac operating room.
Methods. From February 2001 to September 2011, 408 patients were evaluated and treated using a mobile c-arm (Table). Four different types of mobile c-arms were used: GE OEC 9800 (325), Siemens Arcadis (5), Philips Veradius (17), Ziehm RFD (61).
Results. A steady increase of the use of mobile c-arm for major cardiac procedures was noted (23 to 43 procedures, p=0.002). There were 3 cases (0.7 %) of uneventfull system crashes. All other 61 TAVI procedures were completed without valve malposition or coronary obstruction. There were no major differences at imaging quality, especially after evaluation of the newest generation of devices. Coronary artery bypass grafts were assessed in 325 patients mainly during implementation of new procedures or in training cases. Anastomotic or graft revision was required in 11/380 anastomoses (3%).Emergency intraoperative coronary angiography for signs of myocardial ischemia was needed in 16 cases. The median procedure duration for coronary evaluation was 22 (10-110) minutes, fluoroscopy time was 413 (89-2282) sec, dose area product was 46,261 (9,381-429,787 mGy/cm2.The amount of contrast agent used was 150 (20 to 600 ml).
Conclusions. The use of new generation mobile c-arms in the cardiac operation room is extremely useful for transcatheter valve and aortic interventions as well as routine coronary artery graft
evaluation. Bail-out procedures can be successfully performed for evaluation of myocardial ischemia, which requireimmediate perioperative measures.