Cardiovascular Surgery in Jehovah’s Witness Patients

Abstract

Background: Jehovah's Witnesses do not accept blood products because of their religious belief. Our hospital takes a stance of offering absolute bloodless medicine for Jehovah's Witness patients when we perform cardiovascular surgery. Objective: The object of this retrospective study was to investigate whether our perioperative strategy for Jehovah's Witness patients undergoing cardiovascular surgery was acceptable. Methods: We retrospectively reviewed 7 Jehovah's Witness patients who underwent cardiovascular surgery between January 2013 and December 2020. The mean age of the cases was 64±10 (49-78) years. All cases involved primary and elective surgeries. Our preoperative optimization protocol for Jehovah's Witness patients included adding an erythropoiesis stimulating agent and iron to achieve a target hemoglobin level of 13 g/dl. The mean initial outpatient hemoglobin levels and preoperative hemoglobin levels were 12.3±2.2 (7.5-14.5) g/dl, 14.1±1.4 (11.1-15.2) g/dl, respectively. Our intraoperative strategy was to introduce meticulous attention to hemostasis and hemodilutional autologous transfusion and intraoperative blood salvage in each case. We also added an erythropoiesis stimulating agent and iron if needed in the postoperative period. Results: There was no in-hospital mortality among patients treated with bloodless medicine. The mean operative time, cardiopulmonary bypass time, and aortic cross clamp time were 307±103 (157-478), 137±28 (115-178), and 90±27 (68-136) min, respectively. There were no postoperative significant postoperative adverse events (myocardial infarction, stroke, reexploration for bleeding, acute kidney injury and surgical site infection）. The mean duration of follow-up was 3.7±2.6 (0.3-7.4) years and we could confirm that all patients were alive with no adverse events. Conclusions: Our perioperative strategy with absolute bloodless medicine for cardiovascular surgery in Jehovah's Witness patients seemed to be acceptable.