Results of open heart surgery in Jehovah's Witnesses patients

ArticleinThe Journal of cardiovascular surgery 50(2):247-50 · May 2009with33 Reads
Source: PubMed
Abstract
The aim of this paper was to evaluate the results in patients from the religious community of Jehovah's Witnesses (JW) undergoing open heart surgery. Between January 1998 and November 2007, 35 patients with a religious background of JW church underwent open heart surgery at the Department of Cardiothoracic Surgery, Medical University of Vienna (Austria). Eighteen patients underwent coronary artery bypass graft (CABG), 11 patients underwent valve surgery and 5 patients underwent combined procedures. One patient underwent isolated ascending aortic replacement. Five patients undergoing CABG were operated without cardiopulmonary bypass (CBP). Mean baseline hematocrit serum levels were 35.8+/-6.3%. The mean decrease of hematocrit serum levels was 20.0+/-21.1% after surgery. The mean decrease of hematocrit serum levels in patients undergoing CABG without CPB was 12.5+/-5.4% and 12.0+/-20.0% in patients after isolated valve replacement. One patient died during the operation. Four patients died in the postoperative period due to anemia. During follow-up, being 34.6+/-34.8 months to date, no cardiovascular related adverse event has been observed. The decrease of hematocrit serum levels is significantly characterizing the postoperative period of open heart surgery in JW. In patients undergoing CABG without CPB and in patients undergoing isolated valve replacement, decrease of hematocrit serum levels was lowest. Therefore, these techniques should be considered for first choice when appropriate. Furthermore, highly normal preoperative hematocrit serum levels and a meticulous surgical technique remain the mainstay of therapy in these patients.
    • "Using similar specialized programs, prior studies have reported excellent outcomes of cardiac surgery in JW.[6][7][8][9][10][11][12] However, most included various types of open heart surger- ies.[13][14][15][16]Comparative studies of perioperative and long-term results following cardiac valve operations are lacking. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: We compared the clinical outcomes of cardiac valve surgery in adult Jehovah’s Witness patients refusing blood transfusion to those in non-Jehovah’s Witness patients without any transfusion limitations. Methods: From 2005 to 2014, 25 Jehovah’s Witnesses (JW group) underwent cardiac valve surgery using a blood conservation strategy. Twenty-five matched control patients (non-JW group) were selected according to sex, age, operation date, and surgeon. Both groups were managed according to general guidelines of anticoagulation for valve surgery. Results: The operative mortality rate was 4.0% in the JW group and 0% in the non-JW group (p = 1.000). There was no difference in postoperative major complications between the groups (p = 1.000). The overall survival rate at 5 and 10 years was 85.6% ± 7.9% and 85.6% ± 7.9% in the JW group, respectively, and 100.0% ± 0.0% and 66.7% ± 27.2% in the non-JW group (p = 0.313). The valve-related morbidity-free survival rates (p = 0.625) and late morbidity-free survival rates (p = 0.885) were not significantly different between the groups. Conclusions: Using a perioperative strategy for blood conservation, cardiac valve surgery without transfusion had comparable clinical outcomes in adult patients. This blood conservation strategy could be broadly applied to major surgeries with careful perioperative care.
    Full-text · Article · May 2016
    • "OPCAB procedures make it possible not only to limit the number of transfusions but to eliminate transfusions altogether [16, 17]. The elimination of blood product transfusion can be essential in the case of patients with religious restrictions, such as Jehovah witnesses [18]. The serum hemoglobin concentration in the OPCAB group remains stable throughout the postoperative period, as presented inTable I. "
    [Show abstract] [Hide abstract] ABSTRACT: There has been a growing interest in off-pump coronary artery bypass (OPCAB) grafting in recent years. Beating-heart surgery is believed to be less invasive as it allows the side effects of extracorporeal circulation to be avoided. The aim of the study was to compare blood product transfusion rates between two groups of patients undergoing surgery for ischemic heart disease with either the off-pump technique or using cardiopulmonary bypass (CPB). There were 152 patients enrolled in the prospective randomized study. All procedures were elective. There were 84 patients (62 men and 20 women) at the mean age of 63.74 ± 7 years who underwent OPCAB (group I), and 68 patients (54 men and 14 women) at the mean age of 63.51 ± 6 years who underwent cardiopulmonary bypass (group II). There were no perioperative deaths. The mean number of grafts was 2.27 ± 0.3 (OPCAB group) and 2.63 ± 0.6 (CPB group) (p < 0.05). The mean number of packed red blood cells transfused in the OPCAB group was 2.31 ± 0.18 units/patient and 3.94 ± 0.30 units/patient in the CPB group (p < 0.05). The mean number of fresh frozen plasma units transfused was 1.13 ± 0.13 in the OPCAB group vs. 1.57 ± 0.15 in the CPB group (p < 0.05). There were 12 patients (14%) in the OPCAB group who had no transfusion. One of the most important advantages of the OPCAB technique is that it makes it possible to reduce the rate of blood product transfusions.
    Full-text · Article · Jun 2014
    • "Starting preoperatively by raising the level of hemoglobin by use of EPO and iron therapy, eliminating any hemodilution, to proper operative field drainage to reduce the incidence of hematomas related to various invasive maneuvers over the course of hospitalization, keeping the hemoglobin value under 15.5 to avoid associated complications with high hematocrit value [16]. The most recent example of this comprehensive multimodality approach is the mini-cardiopulmonary bypass system that we have been using for the last three years, combined with retro-priming and a cell saver161718192021 which maintains a constant hemoglobin level, often low in cardiac patients. Volume expansion in these patients is associated with a real risk of hemodilution and active participation of the anesthetist is essential to avoid additional iatrogenic vasoplegia, which is greatly facilitated by concentration-aimed ultra-fasttrack anesthesia protocols [22]. "
    [Show abstract] [Hide abstract] 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.
    Full-text · Article · Sep 2012
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