Operative Repair of Type A Aortic Dissection in Jehovah's Witnesses: Insights From a Case Series

Jehovah's Witnesses are known to refuse allogeneic blood products. Consequently, many surgeons will decline to perform aortic surgery on this patient group, given their higher risk. We present here a case series describing operative repair of type A aortic dissection without the use of allogeneic blood products.

From 2018 to 2021, 6 Jehovah's Witness patients underwent open repair of type A aortic dissection. We reviewed preoperative characteristics, diagnostic workup, operative technique, and postoperative outcomes. We also looked specifically at use of autologous whole blood, Cell Saver (Haemonetics) transfusion, synthetic clotting factors (recombinant factor VIIa), and albumin and prothrombin complex concentrate when allowed.

Modified hemiarch replacement was performed with the branched single-anastomosis frozen elephant trunk repair (B-SAFER) technique in 4 patients; 2 patients received a standard hemiarch replacement. Aortic valve replacement was performed in 2 patients; root replacement was performed in 1 patient. There were no immediate postoperative coronary complications, strokes, or instances of renal failure. Average decrease in hemoglobin concentration after surgery was 2.3 ± 1.5 g/dL (mean ± SD). Thirty-day mortality was 0. Five of 6 patients survived to discharge, and all survivors to discharge were still alive at the time of submission.

Bloodless aortic dissection repair in these rare patients can be performed safely in specialized centers using the techniques described. Furthermore, we believe that these techniques can be applied to the general population of patients undergoing emergent cardiac operation to avoid allogeneic transfusions.