Trends in cardiac surgery in Israel, 1985-2002

Background: Reports from Europe and North America indicate that significant changes have occurred in the practice of cardiac surgery in the last two decades. Objectives: To examine the trends and case-mix in cardiac surgery in Israel and their relationship with changes in invasive cardiology. Methods: We analysed data collected by the Ministry of Health from all cardiac centers in Israel from 1985 to 2002. Results: 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. Conclusions: 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.