The Heart of the Matter

Blogs by Dr. Lawrence Rudski, Montreal Jewish General Hospital, and Professor Ehud Raanani, Sheba Medical Center

Update from Dr. Lawrence Rudski, Jewish General Hospital’s Azrieli Heart Centre

This month I had the privilege of travelling to Tel Aviv to represent the Jewish General Hospital’s Azrieli Heart Centre at the Israel Heart Society’s Annual Scientific Sessions. Walking back from the faculty dinner in Sarona, talking to the Senior Leadership of the American College of Cardiology, we came upon a beautiful view of the signature Azrieli Towers, and with great pride, I told them that those were the Azrieli Towers, told them about our Heart Centre, but stopped short of saying that the towers were named after our centre.

The Azrieli family from patriarch to matriarch to children have provided the world with many gifts in the arts, in remembering history – as I write this, it is Yom Hashoah – , in addressing everyone’s special needs, and of course in health care.  My personal world touches on all of these, but institutionally, the JGH is blessed to have been given the gift of the Azrieli Heart Centre. It’s funny – as Director of Cardiology who is responsible for growth but also quality, when I learned that our request was granted – walking back to the airport after presenting to their Canadian and Israeli Board of Directors some 3 years ago in Toronto- I wondered if we were “good enough” to receive this exceptional gift. I was able to “sell,” but was I able to “deliver.”  What I should have appreciated was that donations like this are not meant to reward excellence but to grow excellence. I was finally greatly relieved when the JGH this year was ranked the top hospital in Quebec and amongst the best in the world.

The Azrieli Heart Centre, through the Azrieli Foundation’s donation, has grown in all key domains in healthcare – compassionate, innovative and expert clinical care through a unique method of care delivery; outstanding teaching to local and international residents and fellows through endowed fellowships and to nurses and allied healthcare professionals through continuous education and training; and cutting edge research that aims to improve the lives of so many, and particularly the frail elderly to whom the JGH provides special care. We support one of the leading programs in pulmonary hypertension in the world. We have initiated a new and unique program in geriatric cardiology, translating basic science to clinical risk prediction to actually modifying one’s risk before invasive procedures. We have initiated a structural cardiology program to complement our leading robotic cardiac surgery program. We will soon be increasing our access to advanced cardiac MRI imaging to make more rapid and accurate diagnosis. And we will be investing in integrating our complex information technology platform through a digital transformation strategy that will bear fruit over the next couple of years, transforming how and where care will be delivered. The central theme of all this is the outstanding patient experience that matter so much to patients and their families.

The Azrieli Heart Centre, the Jewish General Hospital, Montreal, and the international community are so lucky to join the Azrieli Foundation in its 30-year (and counting) mission that we all share – that of Tikun Olam – leaving the world a better place. Toda Raba, Yashar Koach and Mazal Tov on your 30^th anniversary.

Update from Professor Ehud Raanani, Director of the Leviev Cardiovascular and Thoracic Center Sheba Medical Center, Tel Hashomer, Israel

Founded in 2008, the Azrieli Cardiac Surgery Intensive Care Unit at Sheba Medical Center, Tel Hashomer, is one of the largest and up-to-date of its kind in the country, having been designed to provide optimum continuous care. Comprising of nine critical care beds, it is an integral part of the Cardiac Surgery Department which is one of the many departments making up Sheba’s state-of-the-art Cardiovascular and Thoracic Treatment and Research Center and is academically affiliated with the Sackler Faculty of Medicine of the Tel Aviv University. Its current Director is Dr Alexander Kogan.

Some of the most up-to-date treatments include:

• Organ Transplantations: The unit serves as a referral center for heart, heart and lung, and lung transplantations, and has treated thus far many transplant surgeries.
• Extracorporeal Membrane Oxygenation (ECMO): is a life-saving artificial heart and/or lung machine. This is used for recovering heart failure patients, or lung failure or heart surgery or as a bridging option to further treatment, when physicians want to evaluate the state of other organs such as the kidneys or brain before performing heart or lung surgery and to assist during high-risk procedures in the cardiac catheterization lab, as a bridge to a heart assist device, such as left ventricular assist device (LVAD), or for patients awaiting lung transplant. The ECMO helps keep tissues well oxygenated, thereby making the patient a better candidate for transplant.
• LV Assist Device: Left ventricular assist devices (LVADs) are another standard treatment that are used in the unit to treat heart transplant candidates.

Hot-off-the-press 2019 publications on novel and exciting research include:

• The of the implications of early recurrent 1R rejections for long-term outcomes after
  heart transplantation (HT) and evaluation of the prognostic significance of 1990 International Society for Heart & Lung Transplantation (ISHLT) grading 1B/2 versus 1A. The Transplant Immunol publication revealed that early recurrent grade 1R rejections negatively affect long-term outcomes. Adverse outcomes are experienced mainly by 1R patients subcategorized as1B/2 and not 1A.
• Is Axillary Better Than Femoral Artery Cannulation in Repair of Acute Type A Aortic Dissection? This study concluded that emergent surgery for both stable and unstable patients with acute type A aortic dissection demonstrated similar survival rates and significantly less renal impairment when using the femoral cannulation approach
• Another study concluded that Type 2 Diabetes Mellitus is an independent predictor for long-term mortality after isolated AVR surgery.
• Another 2019 publication in the European Journal of Cardiothoracic Surgery suggests that in a real-world setting, only approximately one-half of diabetic patients with multi-vessel disease are referred to surgical revascularization despite guideline indications. Surgical compared to percutaneous revascularization in this population was associated with improved long-term survival that became evident 7 months after the revascularization procedure.