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Open Heart Surgery in Jehovah's Witnesses: A Propensity Score Analysis
Hannes Müller1, Thomas Ratschiller1, Wolfgang Schimetta2
1Department of Cardiac, Vascular, and Thoracic Surgery, Kepler University Hospital, Linz, Austria.
The Annals of Thoracic Surgery
|August 14, 2019
Summary
Jehovah's Witnesses undergoing open heart surgery can achieve successful outcomes without blood transfusions. Patient blood management strategies, including preoperative optimization and minimizing blood loss, are key to low morbidity and mortality in these unique cases.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Patient Blood Management
Background:
- Jehovah's Witnesses (JW) decline allogeneic blood transfusions, presenting unique challenges for major surgeries like open heart procedures.
- This study retrospectively analyzed the experience with JW patients undergoing cardiac surgery.
Purpose of the Study:
- To evaluate the outcomes of open heart surgery in Jehovah's Witnesses using patient blood management strategies.
- To compare outcomes between JW patients and non-JW patients who accepted blood transfusions.
Main Methods:
- Retrospective review of 35 adult JW patients undergoing cardiac surgery between 2008 and 2017.
- Propensity score matching was used to compare JW patients with non-JW patients who received transfusions.
- Patient blood management strategies were implemented for all JW patients.
Main Results:
- No significant differences in clinical or operative data were observed between JW and non-JW patients.
- JW patients exhibited higher hemoglobin and hematocrit levels preoperatively and throughout hospitalization.
- Perioperative red blood cell loss was significantly lower in JW patients (619 mL vs 929 mL).
- Major complication rates, in-hospital mortality (2.9% in both groups), and long-term survival were comparable between groups.
Conclusions:
- Patient blood management enables successful open heart surgery for Jehovah's Witnesses with low morbidity and mortality.
- Preoperative hemoglobin optimization and minimizing perioperative blood loss are crucial for preventing complications and transfusions in JW patients.