Hybrid OR’s of the Future- Identifying Industry Partners

Joseph L. Fredi, MD, FACC, FACP

Vanderbilt Heart and Vascular Institute

Interventional Cardiovascular Medicine

Vanderbilt University Medical Center

Nashville, TN

“The Best Way to Predict the Future is to Invent It”

Alan Kay

Dr. Norman Shumway

Disclosures

None

Hybrid Cardiac Therapy

Minimally Invasive Surgery

Coronary Revascularization

Transcutaneous Aortic Valve Replacement (TAVR)

TVAR and EVAR

Arrhythmia Surgery

Congenital Heart Disease

Hybrid Cardiac Therapy: minimally invasive approach-mitral valve

coronary hybrid revascularization

•surgery and endovascular treatment can be simultaneous.

•transradial approach

•sterility

•camera angles

other equipment-IVUS, FFR, rotational atherectomy, etc

Hybrid Cardiac Therapy

Minimally Invasive Surgery

Coronary Revascularization with minimally invasive MV surgery

Transcutaneous Aortic Valve Replacement (TAVR)

TVAR and EVAR

Arrhythmia Surgery

Congenital Heart Disease

From left, Joseph Fredi, M.D., David Zhao, M.D., and John Byrne, M.D., perform the new trans-catheter aortic valve-replacement procedure in Vanderbilt’s hybrid OR. (Photo by Joe Howe

What does the perfect Hybrid OR look like?

•unimpeded anesthesia access to patient

•images quickly head to foot

•table controls for imaging don’t get in the way

•minimizes floor space

•minimizes overhead structures, rails, cables- dirt/germ collectors

•great lighting that can get out of the way-surgeon vs. angiographer

•can image and move equipment when table tilted

•allows real time CT angiography-fast

•does 3D reconstruction and image marking/memory

•large monitors that don’t get in the way and are easy to move-Booms, Booms, more Booms

•allows import of prior imaging studies

•can do all this and not breach sterility

Hybrid OR Considerations

•Location-near cath labs and cardiac OR’s

•Room Size-larger than a standard OR-8-20 people-at least 70-80 sq meters, lead shielding, reinforce ceiling and floors

•Lights and Monitors-Booms; conventional lighting won’t work-collides with imaging equipment

•Hygiene-get off the ceiling and move to the floor-or get a robotic system

•Table-needs to work as an angiographic table at any angle/tilt

•CT-import, image fusion, or real time

•Image trackers

Players in Hybrid OR Market

Dr. Fredi, my team may have one slide to offer you additional info for recent

updates to our Hybrid OR offering

GE Hybrid OR Merging capabilities. Expanding opportunities.

The New Hybrid OR.

• Robust portfolio

• Simple to install, easy and

comfortable to use

• Expert GE Service and

Clinical support teams

• A safe investment

OEC Hybrid Endovascular Solution NuBOOM® M4 9900 12”II VAS MTS Elite C-Arm Stille ImagiQ* Table

Articulating Boom Arms hold monitors – view OR information in the surgical field

Up to 8 shelves, reduce carts and hazards

Bolts to the floor, no ceiling mount required

High Definition Split Screen monitors – view intrs-operative ; i.e.: fluoro, camera, Ultrasound, PACS, etc.

Open architecture, works with most image suppliers

• Standard C arm or Motorized C-arm with Table Side Control

• Precision imaging processing using Dynamic Range Management technology

• Fast imaging processing

• Articulating workstation monitors

• Ability to obtain oblique images

• Low dose & Pulse Fluoroscopy

• Less scatter radiation with tube under table

• Tri Mode II - 12”, 9” 6” FOV

4 Way Float

Iso Centric Capabilities-lateral tilt around a vertical axis

Carbon Fiber Top-less attenuation of the beam

Large unobstructed floor-clearance for C Arm maneuverability

Convenient table side controls

Optional Fistula Armboard

NuBOOM, from CompView Medical, is a digital image communication management system being distributed by GE Healthcare

*ImagiQ Table, from Stille-Sonesta is being distributed by GE Healthcare

OEC Hybrid Endovascular Solution Stille ImagiQ* Table

Articulating Boom Arms hold monitors – view OR information in the surgical field

Up to 8 shelves, reduce carts and hazards

Bolts to the floor, no ceiling mount required

High Definition Split Screen monitors – view intrs-operative ; i.e.: fluoro, camera, Ultrasound, PACS, etc.

Open architecture, works with most image suppliers

4 Way Float

Iso Centric Capabilities-lateral tilt around a vertical axis

Carbon Fiber Top-less attenuation of the beam

Large unobstructed floor-clearance for C Arm maneuverability

Convenient table side controls

Optional Fistula Armboard

NuBOOM, from CompView Medical, is a digital image communication management system being distributed by GE Healthcare

*ImagiQ Table, from Stille-Sonesta is being distributed by GE Healthcare

Innova IGS OR Expanding your capabilities

Innova integrates easily in the OR environment

Sterility and Visualization

• More easily meets aseptic requirements

- No rails nor cabling over the sterile field

- No tracks interfering with air flow

• Allows optimal visualization

- No tracks on the ceiling1 for flexible positioning of the monitors and surgical lamps at the head or on the side of the table

- Flexible monitors boom implantation

- Flexible surgical lamps boom implantation

Performance Peace of mind Flexibility Clinical confidence

1 Using surgical suspensions with the open monitor suspension option

Postoperative control and yearly surveillance

(T)EVAR Assist

Understand patient anatomy and plan appropriate therapy strategy

Postoperative DSA or Innova3D imaging Monitoring of the size of the aneurysm sac with VesselIQ AW application

Use visualization techniques to navigate in the anatomy and deliver planned therapy

Real time guidance with Blended Roadmap, Innova Vision technologies and direct control from tableside

Visualization of the anatomy and key measurements with VesselIQ AW application. Manipulate CT or Innova 3D images at tableside

Assess Plan Guide

Flexibility Clinical confidence Peace of mind Performance

Immediately determine success of therapy delivery to region of interest

Valve Assist

Understand patient anatomy and plan appropriate therapy path and strategy

Valve Planning based on Innova 3D Cardiac or pre-op CT

Immediate determination of success of therapy delivery with CardioICE synchronized ultrasound system

Use visualization techniques to locate region of interest and deliver planned therapy

Real-time guidance with Innova HeartVision technologies and direct control from tableside

Assess Plan Guide

Flexibility Clinical confidence Peace of mind Performance

Hybrid OR

February 23, 2012

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FlexMove

3D Ultrasound

Heart Navigator

Partnerships

Training

OR table integration

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FlexMove

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FlexMove

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FlexMove

3D Ultrasound

Heart Navigator

Partnerships

Training

OR table integration

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FlexMove

3D Ultrasound

Heart Navigator

Partnerships

Training

OR table integration

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HeartNavigator Procedure guidance for TAVI: Supports in device sizing and planning Provides live guidance with overlay of all relevant anatomical reference points Allows for re-use of previously acquired CTA’s First FDA approved TAVI guidance tool

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XperCT Cardiac

Procedure guidance for TAVI: Enables planning and storing of optimal X-ray view angles Provides real time reference image for live guidance Based on fast rotational scan during procedures

Artis zeego in the Hybrid OR

Robotic System Innovation in Surgery

• Multi-axis revolution

• 8 rotational axes for previously unknown degrees of freedom and flexibility

– Compact C-arm, great access for surgeons, anaesthetists and the whole OR-team

Positioning capabilities

Left-side Position

Excellent left-side access to patient

Table at 30 degrees

All the free area at head end

Artis zeego unique – "Table tracking"

Synchronization of c-arm and table

Immediate, fast table tilt without time delay and collision during ongoing imaging

Angiography is possible with all tilt and cradle angles

Artis zeego unique –

"Large volume Syngo Dyna CT"

Acquisition of CT-like images at table side with a field of view of 25 cm

Imaging of the whole thoracic aorta, both kidneys, the whole spine etc. in one

syngo DynaCT run

Conventional systems offer syngo DynaCT with a coverage of 18 cm only

Lower radiation dose for the patient

Less time-consuming than doing two conventional syngo DynaCT runs

syngo Aortic ValveGuide Efficient guidance for valve

implantations

No user interaction needed - No need to leave sterile area

Reconstruction, segmentation and landmarks in less than 20 sec.

Potential to save contrast media and dose compared to conventional CT or 2D imaging

Automated Workflow

Rotational angiography syngo DynaCT Cardiac

Reconstruction

syngo Aortic ValveGuide

Segmentation

syngo Aortic ValveGuide Key features

– Automised segmentation

of the aortic root based on intraprocedural syngo DynaCT Cardiac images

– Landmarks, e.g.

coronary artery ostia

– Indication of perpendicular

view and adjustment

of C-arm projection

Better planning and orientation during valve deployment

– Contour view of the

aortic root in the 3D overlay with live fluoro

Thank You