Raanani Ehud, Keren Anat, Kogan Alex, Kornowski Ran, Vidne Bernardo A
Department of Cardiothoracic Surgery, Rabin Medical Center (Beilinson Campus), Petah Tiqwa, Israel.
Isr Med Assoc J. 2004 Mar;6(3):131-3.
Reports from Europe and North America indicate that significant changes have occurred in the practice of cardiac surgery in the last two decades.
To examine the trends and case-mix in cardiac surgery in Israel and their relationship with changes in invasive cardiology.
We analysed data collected by the Ministry of Health from all cardiac centers in Israel from 1985 to 2002.
Three periods were identified: the 1980s, when a relatively small number of operations were performed; 1990-1994, characterized by a dramatic rise in the number of operations; and 1994-present, characterized by a small decline and stabilization in the rate of operations. The percentage of valve procedures increased significantly from 15% of all cardiac surgeries in 1991 to 21% in 2002 (P = 0.002). In addition, the chance of a diagnostic coronary angiography being followed, in the same patient, by an interventional procedure such as percutaneous transluminal coronary angioplasty or by a coronary artery bypass graft increased dramatically from 42% in 1991 to 69% in 2002. At Rabin Medical Center, there was a constant decline in the percent of repeated CABGs out of the total CABGs performed, from 6.7% in 1996 to 1.3% in 2002.
Despite the rise in the rate of percutaneous coronary interventions since 1991, there has been no significant decline in the rate of CABGs performed. However, there is a significant shift to more complex operations. The number of repeated CABG operations has significantly decreased and, in view of the growing use of arterial grafts and further improvements in invasive cardiology techniques, we expect this decline to continue.
来自欧洲和北美的报告表明，在过去二十年中心脏外科手术的实践发生了重大变化。
研究以色列心脏外科手术的趋势和病例组合及其与侵入性心脏病学变化的关系。
我们分析了以色列卫生部从1985年至2002年从所有心脏中心收集的数据。
确定了三个时期：20世纪80年代，当时进行的手术数量相对较少；1990 - 1994年，其特点是手术数量急剧上升；1994年至今，其特点是手术率略有下降并趋于稳定。瓣膜手术的百分比从1991年占所有心脏手术的15%显著增加到2002年的21%（P = 0.002）。此外，同一名患者在进行诊断性冠状动脉造影后，接受诸如经皮腔内冠状动脉成形术等介入手术或冠状动脉搭桥术的几率从1991年的42%急剧增加到2002年的69%。在拉宾医疗中心，重复冠状动脉搭桥手术占所进行的总冠状动脉搭桥手术的百分比持续下降，从1996年的6.7%降至2002年的1.3%。
尽管自1991年以来经皮冠状动脉介入治疗率有所上升，但冠状动脉搭桥手术的执行率并未显著下降。然而，手术明显转向更复杂的操作。重复冠状动脉搭桥手术的数量显著减少，鉴于动脉移植物的使用增加以及侵入性心脏病学技术的进一步改进，我们预计这种下降趋势将持续。
