Redo Triple Coronary Artery Bypass Graft on a Jehovah’s Witness Patient: A “Tailored” Approach

Abstract

a 66-year old woman, Jehovah's Witness, diabetic Type 2 and hypertensive with a history of triple coronary artery bypass graft (CABG) surgery in 2007 was submitted to a redo CABG for failure of all previous grafts. She had a myocardial infarct in April 2013 and had post myocardial infarction angina on exertion (CCS 2). The preoperative ejection fraction was 53%. The preoperative haemoglobin (Hb) was 14.1 g/dL. After freeing the heart from epicardial and pericardial adhesions due to previous surgery, a triple venous CABG was performed on-pump: on left anterior descending (LAD) artery, postero-lateral (PL) artery and posterior descending (PD) artery. At the end of the operation, the Hb value was 10.7 g/dL. The postoperative bleeding at the drain removal was 230 ml. The patient was discharged home on the seventh postoperative day with no complications. The Hb value was 9.5 g/dL. At present, she is alive, well and asymptomatic.

Outcomes of cardiac surgery in Jehovah’s Witness patients: A review

“…12 A number of complex cardiac surgery case reports demonstrate this and express the importance of referral to tertiary centres. 12,28 This was especially noted in a case report by Papalexopoulou et al, 12 where a Witness patient was eventually operated on for an aortic dissection following previous assessment at two other centres. A further factor that could be assessed at the preoperative stage for Witness patients is the relative risk of patients requiring a blood transfusion during surgery.…”

“…12 A number of complex cardiac surgery case reports demonstrate this and express the importance of referral to tertiary centres. 12,28 This was especially noted in a case report by Papalexopoulou et al, 12 where a Witness patient was eventually operated on for an aortic dissection following previous assessment at two other centres.…”

“…Additionally, many authors within the literature offer protocols from their own centres for the conservation of blood products and management of patients who refuse these pre, post and peri-operatively. 17,27,28 In addition to these protocols, guidelines and recommendations exist, produced by the National Institute of Health and Clinical Excellence (NICE), the Royal College of Surgeons of England and the Joint United Kingdom (UK) Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee. 11,23,29 These provide further clarification on the alternatives to blood transfusions and the key information from these has been summarised in Table 1.…”