ABSTRACT
BACKGROUND: Refusal of heterogenic blood products can be for religious reasons as in Jehovah's Witnesses or otherwise or as requested by an increasing number of patients. Furthermore blood reserves are under continuous demand with increasing costs. Therefore, transfusion avoidance strategies are desirable. We describe a historic comparison and current results of blood saving protocols in Jehovah's Witnesses patients. METHODS: Data on 250 Jehovah's Witness patients operated upon between 1991 and 2003 (group A) were reviewed and compared with a second population of 250 patients treated from 2003 to 2012 (group B). RESULTS: In group A, mean age was 51 years of age compared to 68 years in group B. An iterative procedure was performed in 13% of patients in group B. Thirty days mortality was 3% in group A and 1% in group B despite greater operative risk factors, with more redo, and lower ejection fraction in group B. Several factors contributed to the low morbidity-mortality in group B, namely: preoperative erythropoietin to attain a minimal hemoglobin value of 14 g/dl, warm blood cardioplegia, the implementation of the Cornell University protocol and fast track extubation. CONCLUSIONS: Cardiac surgery without transfusion in high-risk patients such as Jehovah Witnesses can be carried out with results equivalent to those of low risk patients. Recent advances in surgical techniques and blood conservation protocols are main contributing factors.
Subject(s)
Bloodless Medical and Surgical Procedures/statistics & numerical data , Cardiac Surgical Procedures/statistics & numerical data , Jehovah's Witnesses , Adult , Aged , Bloodless Medical and Surgical Procedures/methods , Cardiac Surgical Procedures/methods , Cohort Studies , Female , Hemoglobins/analysis , Humans , Male , Middle Aged , Mortality , Risk Factors , Statistics, Nonparametric , Treatment OutcomeABSTRACT
BACKGROUND: Jehovah's Witnesses who require cardiac surgery represent a challenge to the physician because of their refusal to accept blood transfusions. Because coronary artery bypass grafting (CABG) is performed by most surgeons under cardiopulmonary bypass (CPB), which has potentially deleterious effects on hemostasis, we used a new concept called minimal extracorporeal circulation (MECC). MECC includes heparin-coated tubing, a centrifugal pump, and an oxygenator. There is no venous reservoir or vent, and suction is used through the cell saver. We assessed the hypothesis that MECC in combination with low-volume blood cardioplegia preserves more hemoglobin than conventional CPB in standard CABG. METHODS: In 40 patients of the Jehovah's Witnesses faith undergoing CABG with the use of MECC and intermittent warm blood cardioplegia, clinical and biological data as well as values for parameters of hemolysis (plasma hemoglobin) and myocardial damage (troponin T) were determined. The results were compared with those of a control group of 40 patients who underwent operations with standard CPB. RESULTS: Demographics, hemodynamics, the number of anastomoses, and CPB and cross-clamp times were comparable between the groups. MECC patients demonstrated significantly lower peak levels of plasma hemoglobin (21.8 +/- 114 mg/dL versus 35.4 +/- 15 mg/dL) and troponin T (0.12 +/- 0.4 ng/mL versus 0.65 +/- 0.7 ng/mL), a higher minimum hematocrit level during CPB (30% +/- 7% versus 23% +/- 6%), and a higher hemoglobin level 2 days after surgery (13 +/- 3 g/100 mL versus 9.4 +/- 0.98 g/100 mL). Preoperative values were not significantly different. CONCLUSION: The use of MECC instead of conventional CPB reduces hemolysis, hemodilution, blood loss, and myocardial damage.
