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The continuing evolution of the cath lab

por John R. Fischer, Senior Reporter | April 12, 2021
Cardiology Operating Room
From the April 2021 issue of HealthCare Business News magazine

Support from professional societies and experts in the field has paved the way for procedures to be performed in outpatient settings, including low-risk coronary angioplasty. Many payors and self-insured employers also prefer the affordability of outpatient and ambulatory labs, compared to ones in hospitals. Still, some patients, like children, are still better off undergoing cath lab exams and operations in a hospital.

“They need the backup of cardiac surgery and cardiac anesthesia and other subspecialists that an ambulatory setting may not have,” Sathanandam said. “Some cath labs for adults have transitioned but I would still say that’s a minority. You need an infrastructure that a tertiary hospital will provide, especially if the patients are very complex.”

Wearing multiple hats
Most modern cath labs are hybrids that can operate as ORs to perform both open-heart surgeries and cardiac catheterization, according to Sathanandam. “Some of these patients that should have had open-heart surgery are now undergoing a minimally invasive procedure in the cath lab. But obviously if they need to have open-heart surgery during their minimally invasive procedure for some reason, you need to be able to do it.”

Other hybrids are beginning to combine peripheral procedures, traditionally found in ambulatory settings, with coronary ones that are just beginning to be performed in labs, according to Marshall. In addition to fluoroscopy, modern-day cath labs are equipped to perform intravascular imaging and intravascular physiology. Some also have integrated CT imaging to guide procedures and newer left ventricular support devices that make them well-suited to care for critically ill patients.

Modern Vascular - Greater demands are being made to build cath labs outside of hospitals and in ambulatory surgical centers and outpatient settings (Photo courtesy of Modern Vascular)
Bortnick’s team at Montefiore used these technologies to transform their own cath lab into a hybrid ICU that could care for both heart and COVID-19 patients at the height of the pandemic. “We take care of the highest number of heart attack patients in all of the boroughs of New York City,” said Bortnick. “We organized ourselves to not only take care of COVID patients, but to keep critical cath lab services available for people coming in with a heart attack or chest pain.”

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