Posttransplant off-pump coronary bypass and laser revascularization in a Jehovah's Witness

Area of Science:

• Cardiovascular Surgery
• Transplant Surgery
• Minimally Invasive Cardiac Procedures

Background:

• A 57-year-old male recipient of a heart transplant 14 years prior presented with severe coronary artery disease.
• The patient had significant blockages in the left main, left anterior descending, and circumflex coronary arteries.
• Adherence to Jehovah's Witness faith precluded the use of blood or blood products during surgical intervention.

Observation:

• The patient underwent coronary artery bypass grafting (CABG) combined with transmyocardial laser revascularization (TMLR).
• These complex cardiac procedures were performed via a left thoracotomy incision, avoiding cardiopulmonary bypass.
• Strict adherence to a no-transfusion policy was maintained throughout the perioperative period.

Findings:

• The combined CABG and TMLR procedure was successfully completed without the need for blood product transfusion.
• The surgical approach through a left thoracotomy without cardiopulmonary bypass facilitated the transfusion-free strategy.
• The patient tolerated the complex cardiac surgery and transfusion-free management well.

Implications:

• This case demonstrates the feasibility of performing complex coronary revascularization, including CABG and TMLR, in a heart transplant recipient without cardiopulmonary bypass and blood transfusions.
• It highlights the importance of tailored surgical strategies and meticulous perioperative management for patients with religious or ethical objections to blood transfusion.
• The findings suggest that advanced surgical techniques can be safely employed to manage severe coronary artery disease in highly selected patient populations, including those with prior transplants and specific transfusion restrictions.