Minimized closed circuit/centrifugal pump extracorporeal circulation: an effective aid in coronary bypass operations in Jehovah's Witnesses

Abstract

Surgical treatment of a Jehovah's Witnesses continues to be a great challenge in cardiac surgery. Different strategies are used to minimize the risk for early mortality, prolonged intensive care unit stay and hospitalization, resulting from anemia. Minimized closed circuit extracorporeal circulations have been shown to reduce adverse effects of conventional CPB. Two patients underwent urgent coronary revascularization for triple-vessel disease. The miniECC (Stöckert) is a phosphorylcholine-coated device which integrates the functions of oxygenation, filtration, and pumping in a compact manner with reduced total surface area and priming volume. After a well-tolerated operation the patients showed only minimal red blood cell damage (free hemoglobin 93 mg/l). Hematocrit levels decreasing perioperatively in both patients only moderately (32% and 30%). In these two instances using miniECC we showed a markedly reduced blood cell damage and myocardial trauma. Furthermore, we observed hematocrit levels being higher as compared to standard CABG patients, providing an optimized startpoint for an uneventful postoperative course. MiniECC can be routinely employed and reduces red blood cell damage. Therefore, it can be an effective aid in CABG operations in Jehovah's Witnesses.

Outcomes in cardiac surgery in 500 consecutive Jehovah's Witness patients: 21 year Experience

“…If these results attain factual status, then for both medical and legal reasons, all efforts must be made to avoid recourse to blood transfusion not only amongst Jehovah’s Witnesses, but in all patients. A review of the existing literature on methods of blood transfusion indicates not only a discordance in practice amongst medical teams, but even amongst members of the same team: yet the morbidity-mortality rates are ubiquitous in the first 30 postoperative days [ 1 , 2 , 23 ]. Therefore, it appears desirable to replace these highly unsystematic methods of transfusion with a protocol of blood conservation which involves all members of the caring team.…”

“…Patients undergoing cardiac surgery receive blood transfusion in 20-80% of cases. Certain studies suggest that half of these transfusions are unnecessary and can be avoided [ 1 , 2 ]. Furthermore, multivariate analyses have identified blood transfusion as an independent factor for mortality in the long term.…”

Versatile minimized system - a step towards safe perfusion

“…3 –10 Minimized cardiopulmonary bypass systems demonstrated significant benefits versus conventional CPB systems in terms of a reduction of the systemic inflammatory response and transfusion requirements, with resultant intact microcirculation. 11 –28 Better myocardial protection 12,29,30 and less norepinephrine requirements 31 during surgery supported by a minimized system in comparison to a conventional system have been reported as well. Moreover, Anastasiadis et al 32 showed, in a meta-analysis, that the use of a minimized circuit reduces the total therapy cost by up to € 1.59 per patient.…”

Blood Conservation Strategy during Cardiac Valve Surgery in Jehovah's Witnesses: a Comparative Study with Non-Jehovah's Witnesses

“…If these results attain factual status, then for both medical and legal reasons, all efforts must be made to avoid recourse to blood transfusion not only amongst Jehovah's Witnesses, but in all patients. A review of the existing literature on methods of blood transfusion indicates not only a discordance in practice amongst medical teams, but even amongst members of the same team: yet the morbidity-mortality rates are ubiquitous in the first 30 postoperative days [1,2,23].…”

“…Certain studies suggest that half of these transfusions are unnecessary and can be avoided [1,2]. Furthermore, multivariate analyses have identified blood transfusion as an independent factor for mortality in the long term.…”