Results of open heart surgery in Jehovah’s Witness patients. Single centre experience

Abstract

AimEvaluation the results in patients from the religious community of Jehovah’s Witness (JW) undergoing open heart surgery at our institution.Material and methodsBetween September 2011 and March 2015, 21 patients with a religious background of the JW church underwent open heart surgery at our institution performed by the same surgical team. Mean age was 68.43 ±8.93 years. There were 13 (61.9%) female patients. Recombinant human erythropoietin was administered to every patient with a hemoglobin value < 12.0 g/dl. Nine patients undergoing isolated coronary artery revascularization were operated on without cardiopulmonary bypass. Seven patients underwent combined surgery and 5 patients underwent aortic valve replacement via ministernotomy. The mean follow-up time was 16.45 ±11.09 months (range: 1.67–44.3 months).ResultsMean baseline hematocrit serum level was 40.15 ±3.34% (range: 34.5–46.1%). Perioperatively the hematocrit serum levels decreased to the mean level of 29.89 ±4.31% (range: 21.4–36.3%). The mean hematocrit value at discharge was 30.85 ±3.59% (range: 23.5–38.4%). One death was observed in the perioperative period. Five (24%) patients suffered from sternum wound infection requiring vacuum-assisted therapy. During the follow-up period 1 patient died due to a non-cardiac related cause.ConclusionsAfter careful preoperative preparation the results of open heart surgery in JW were very good, including combined procedures. The decrease of hematocrit serum levels significantly characterizing the postoperative period was highly acceptable in this series. Nevertheless, the number of sternum wound infections was a limiting factor for prompt postoperative recovery.

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

“…Only three of the 11 comparative studies reported the data, but of the three studies, no difference in rates was found. 45,47,50 Again, non-comparative studies found similar results (comparative: 0%-3.06%; 45,47,50 non-comparative 0%-5% 4,17,44,58 ). Vaislic et al 17 reported a drop in 30-day mortality with time, stating 3% in those operated on between 1991 and 2003 and 1% for those between 2003 and 2012.…”

“…These figures are similar to those found in non-comparative studies, which ranged from 0% to 14.3%. 8,17,32,44,53,54,58 One study by Ramiaramanana et al 54 split the 153 Witness study population into low and high risk patients using their co-morbidities. Of the 13 classed as high risk, 3 died (23%), which was significantly higher than those in the low risk group (3 of 140 (2.1%), p = 0.001).…”

“…Overall hospital length of stay (LOS) was reported for 10 out of 11 comparative studies, 2,16,21,46,47,[50][51][52] with three reporting a significantly decreased LOS for Witness patients compared to the non-Witness group (10.3 vs 13.4 days, p = 0.032; 45 7.0 vs 8.0 days, p < 0.001 16 and 12.2 vs 17.3 days, p = 0.05, 48 respectively). Studies which only described outcomes for Witnesses stated similar LOS times ranging from 5, 8 8.1 ± 4.8, 4 9.83 ± 7.92 53 and 12.81 ± 6.58 44 days.…”

Outcome of Jehovah's Witnesses after adult cardiac surgery: systematic review and meta‐analysis of comparative studies

“…In recent years, perioperative hemoglobin (Hb) optimization, reinfusion of mediastinal shed blood, and methods aiming at reducing perioperative blood loss allowed cardiac surgery procedures in JWs as demonstrated in a number of one-arm studies. [5][6][7][8] Nonetheless, comparative analyses including patients not refusing blood transfusion are necessary to better evaluate the outcome of JWs after cardiac surgery and the safety and potential benefits of blood transfusion-free surgery. These issues have been investigated in this meta-analysis.…”

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

“…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 saver [16][17][18][19][20][21] 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].…”