Cardiac surgery during wartime in Israel.

BACKGROUND: The war that began on October 7th, 2023, has impacted all major tertiary medical centers in Israel. In the largest cardiac surgery department in Israel there has been a surprising increase in the number of open-heart procedures, despite having approximately 50% of surgeons recruited to military service. The purpose of this study is to characterize this increase in the number of operations performed during wartime and assess whether the national crisis has affected patient outcomes. METHODS: The study was based on a prospectively collected registry of 275 patients who underwent cardiac surgery or extracorporeal membrane oxygenation (ECMO) during the first two months of war, October 7th 2023 - December 7th 2023, as well as patients that underwent cardiac surgery during the same period of time in 2022 (October 7th, 2022 - December 7th, 2022). RESULTS: 120 patients (43.6%) were operated on in 2022, and 155 (56.4%) during wartime in 2023. This signifies a 33.0% increase in open-heart procedures (109 in 2022 vs. 145 in 2023, p-value 0.26). There were no significant differences in the baseline characteristics of patients when comparing the 2022 patients to those in 2023. No significant differences between the two groups were found with regards to intraoperative characteristics or the type of surgery. However, compared to 2022, there was a 233% increase in the number of transplantations in the 2023 cohort (p-value 0.24). Patient outcomes during wartime were similar to those of 2022, including postoperative complications, length of stay, and mortality. CONCLUSIONS: Patients who underwent cardiac surgery during wartime presented with comparable outcomes when compared to those of last year despite the increase in cardiac surgery workload. There was an increase in the number of transplants this year, attributed to the unfortunate increase in organ donors.

Impact of pre-existing right or left bundle branch block on patients undergoing surgical aortic valve replacement.

OBJECTIVES: Contemporary data on the prognostic impact of pre-existing left or right bundle branch block on clinical outcomes after aortic valve (AV) replacement are limited. The aim of this study was to evaluate the impact of pre-existing bundle branch block on clinical outcomes in patients undergoing AV replacement. METHODS: Data from patients who underwent AV replacement surgery between 2004 and 2020 were obtained from our departmental database. RESULTS: Of the 2704 study patients, 203 (7.5%) had pre-existing bundle branch block and 2501 (92.5%) had normal atrioventricular conduction. The mean age was 68 (13) years, 1697 (63%) were male and 683 (25%) had a unicuspid or bicuspid AV. The in-hospital mortality rate was higher in patients with pre-existing bundle branch block compared to those without on admission (5.9% vs 2.9%, P = 0.032), and more frequent in patients with left compared with right bundle branch block (11.9% vs 4.3%, P = 0.003). New pacemaker implantation was most frequent in those patients with pre-existing left bundle branch block, followed by right and no bundle branch block on admission (28.6% vs 7.5% vs 2.8% respectively, P < 0.001; odds ratio 4.96 95% confidence interval 2.96-8.08, P < 0.001). The 10-year cumulative survival rate was lower in patients with bundle branch block compared with patients with no bundle branch block (76.8% vs 82.8%, log-rank P < 0.001; hazard ratio 0.73, confidence interval 0.54-0.99, P = 0.042). CONCLUSIONS: This study indicates that patients with pre-existing bundle branch block have a higher incidence of pacemaker implantation and all-cause mortality after AV replacement compared with patients without a conduction disturbance.