Cardiovascular Surgery in Conflict Zones: Insights from 2169 Cases in Wartime Yemen

Background: This study represents the first registry to assess patients’ clinical characteristics and key predictors of 30-day post-cardiovascular surgery mortality in wartime Yemen. Methods: This study retrospectively analyzed 2169 patients who underwent cardiac surgery. Comprehensive patient data were extracted from Nabdh Al-Hayat Cardiac Center registries across Hadhramaut Governorate, Republic of Yemen, over 7 years from 2018 to 2024. Results: The study cohort comprised predominantly adult patients, with 69% aged 18 years and above, while 31% were under 18 years of age. The overall survival rate was high (95%), yet 5% of the patients experienced 30-day postoperative mortality. Cold cardioplegia and certain solution types were associated with increased mortality. Heart failure and ventricular dysfunction accounted for most mortality, though non-cardiac factors, such as cerebral hemorrhage and multi-organ failure, contributed as well. Conclusions: While Yemen’s crises have devastated healthcare delivery, the 30-day postoperative mortality data highlight the resilience of coordinated efforts. However, current standards remain far from universal benchmarks, highlighting the urgent need to rebuild local capacity and ensure equitable access to cardiac surgical services nationwide.