Cardiosurgical Procedures in Patients Refusing Blood Transfusions: IKEM Outcomes
Authors:
O. Szárszoi; I. Netuka; MUDr. David Janák, Ph.D.; M. Urban; J. Malý; J. Bešík; D. Turek; P. Kačer; I. Skalský; J. Pirk
Authors‘ workplace:
Klinika Kardiovaskulární chirurgie IKEM Praha, přednosta: prof. MUDr. Jan Pirk, DrSc.
Published in:
Rozhl. Chir., 2011, roč. 90, č. 2, s. 102-105.
Category:
Monothematic special - Original
Overview
Introduction:
Jehovah’s Witnesses who require cardiac operation represent a specific challenge to the physicians. Members of this faith will not accept blood or blood products under any circumstances on the basis of religious grounds. Nevertheless cardiac operations belong to surgical interventions with potential severe bleeding and necessity of blood transfusions.
The aim of the study:
The aim of this retrospective study was to analyze clinical data, operative and postoperative courses of patients operated at IKEM who refused blood transfusions.
Methods and Results:
From January 1995 to August 2010, 73 Jehovah’s Witnesses ranging in age from 19 to 82 years underwent cardiac surgery at our institute. Aortocoronary bypass were performed in 34 patients, valve surgery in 25 patients, 6 patients underwent concomitant aortocoronary bypass and valve surgery, 2 patients underwent aortocoronary bypass and resection of the left ventricle aneurysm and 2 patients underwent atrial septal defect repair and tricuspid valve anuloplasty. Ventricular septal sefect repair, atrial septal defect repair, Cor Cap device implantation and left ventricular epicardial electrodes implantation were performed in the other patients. Early 30-days mortality was 2.8 % (2 patients).
Conclusion:
We can conclude that cardiac surgery in Jehovah’s Witnesses can be performed safety without blood transfusion and belongs to standard operating procedures at our institution.
Key words:
cardiac surgery – Jehovah’s Witnesses – blood transfusion
Sources
1. Cooley, D. A., Bloodwell, R. D., Beall, A. C. Jr., Hallman, G. L. Cardiac valve replacement without blood transfusion. Am. J. Surg., 1966; 112: 743–751.
2. Cooley, D. A., Crawford, E. S., Howell, J. F., Beall, A. C. Jr. Open Heart Surgery In Jehovah‘s Witnesses. Am. J. Cardiol., 1964; 13: 779–781.
3. El Azab, S. R., Vrakking, R., Verhage, G., Rosseel, P. M. Safety of cardiac surgery without blood transfusion: a retrospective study in Jehovah’s Witness patients. Anaesthesia, 2010; 65: 348–352.
4. Goodnough, L. T. Risks of blood transfusion. Crit. Care Med., 2003; 31: S678–686.
5. Chiariello, L., Sandiford, F. M., Cooley, D. A. Aortocoronary Bypass In Jehovah’s Witnesses Results In 36 Patients. Cardiovasc. Dis., 1974; 1: 87–94.
6. Kleinman, S., Chan, P., Robillard, P. Risks associated with transfusion of cellular blood components in Canada. Transfus. Med. Rev., 2003; 17: 120–162.
7. Kuduvalli, M., Oo, A. Y., Newall, N., Grayson, A. D., Jackson, M., Desmond, M. J., Fabri, B. M., Rashid, A. Effect of peri-operative red blood cell transfusion on 30-day and 1-year mortality following coronary artery bypass surgery. Eur. J. Cardiothorac. Surg,. 2005; 27: 592–598.
8. Madjdpour, C., Spahn, D. R. Allogeneic red blood cell transfusions: efficacy, risks, alternatives and indications. Br. J. Anaesth., 2005; 95: 33–42.
9. Magovern, J. A., Sakert, T., Benckart, D. H., Burkholder, J. A., Liebler, G. A., Magovern, G. J. Sr., Magovern, G. J. Jr. A model for predicting transfusion after coronary artery bypass grafting. Ann. Thorac. Surg., 1996; 61: 27–32.
10. Marcucci, C., Madjdpour, C., Spahn, D. R. Allogeneic blood transfusions: benefit, risks and clinical indications in countries with a low or high human development index. Br. Med. Bull., 2004; 70: 15–28.
11. Murphy, G. J., Reeves, B. C., Rogers, C. A., Rizvi, S. I., Culliford, L., Angelini, G. D. Increased mortality, postoperative morbidity, and cost after red blood cell transfusion in patients having cardiac surgery. Circulation, 2007; 116: 2544–2552.
12. Ott, D. A., Cooley, D. A. Cardiovascular surgery in Jehovah’s Witnesses. Report of 542 operations without blood transfusion. JAMA, 1977; 238: 1256–1258.
13. Reyes, G., Nuche, J. M., Sarraj, A., Cobiella, J., Orts, M., Martin, G., Celemín, R., Montalvo, E., Martínez-Elbal, L., Duarte, J. Bloodless cardiac surgery in Jehovah_witnesses: outcomes compared with a control group. Rev. Esp. Cardiol., 2007; 60: 727–731.
14. Stamou, S. C., White, T., Barnett, S., Boyce, S. W., Corso, P. J., Lefrak, E. A. Comparisons of cardiac surgery outcomes in Jehovah’s versus Non-Jehovah’s Witnesses. Am. J. Cardiol., 2006; 98: 1223–1225.
15. Surgenor, S. D., DeFoe, G. R., Fillinger, M. P., Likosky, D. S., Groom, R. C., Clark, C., Helm, R. E., Kramer, R. S., Leavitt, B. J., Klemperer, J. D., Krumholz, C. F., Westbrook, B. M., Galatis, D. J., Frumiento, C., Ross, C. S., Olmstead, E. M., O’Rennor, G. T. Intraoperative red blood cell transfusion during coronary artery bypass graft surgery increases the risk of postoperative low-output heart failure. Circulation, 2006; 114: I43–48.
16. Williamson, L. M., Lowe, S., Love, E. M., Cohen, H., Soldan, K., McClelland, D. B., Skacel, P., Barbara, J. A. Serious hazards of transfusion (SHOT) initiative: analysis of the first two annual reports. BMJ, 1999; 319: 16–19.
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Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2011 Issue 2
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