Original article
Adult cardiac
Cardiac Surgery in Jehovah's Witness Patients: Ten-Year Experience

https://doi.org/10.1016/j.athoracsur.2011.06.029Get rights and content

Background

Cardiac surgery in Jehovah's Witnesses poses unique challenges. We have developed a comprehensive multimodality program for these patients and have obtained excellent results.

Methods

Ninety-one Jehovah's Witness patients underwent cardiac surgery between 2000 and 2010. Preoperative, intraoperative, and postoperative considerations in the conduct of bloodless surgery in the Jehovah's Witness population are discussed. Mortality for isolated coronary artery bypass graft surgery and isolated aortic valve replacement was compared with predicted mortality from The Society of Thoracic Surgeons (STS) risk models. Perioperative outcomes were stratified by urgent and elective status of operations.

Results

Mean age was 65 ± 12.4 years. Comorbid conditions included hypertension (84.6%), diabetes mellitus (48.4%), previous myocardial infarction (23.1%), chronic lung disease (38.5%), peripheral vascular disease (20.9%), and renal failure (11%). In-hospital mortality was 5.5% (n = 5). Mortality for isolated coronary artery bypass graft surgery and isolated aortic valve replacement was 2.2% (observed to expected ratio = 1.05, 95% confidence interval: 0 to 3.02) and 5.6% (observed to expected = 1.46, 95% confidence interval: 0 to 3.76), respectively. Other complications included reoperation (all = 8.8%, cardiac = 2.2%), sepsis (2.2%), sternal wound infection (1.1%), transient ischemic attack (1.1%), renal failure requiring dialysis (1.1%), and prolonged ventilation (18.7%). Major complication rates were not significantly different between the elective group and the urgent group.

Conclusions

Bloodless cardiac surgery in Jehovah's Witness patients can be performed with excellent outcomes in both elective and urgent situations. Mortality rates for isolated coronary artery bypass graft surgery and isolated aortic valve replacement are within the expected 95% confidence intervals of STS predicted mortality.

Section snippets

Patients

From May 2000 to April 2010, 94 JW patients underwent cardiac surgery at PAH. Of these, data were unavailable for 2 patients. One patient consented to and received blood products, and was excluded from this study. Data for the remaining 91 patients were collected from the hospital cardiac surgery database.

Bloodless Medicine Program at PAH

The Center of Bloodless Medicine and Surgery at PAH receives approximately 1,000 outpatient visits per year. The JW patients comprise approximately 95% of these visits. The “bloodless medicine

Preoperative Risk Factors

Preoperative demographics and comorbidities are depicted in Table 1. Fifty-five patients (60.4%) were able to be optimized as outpatients, and 36 were admitted to the hospital preoperatively (mean preoperative length of stay 14.6 ± 18.3 days, median 6.5). The goal of preadmission of these patients was optimization of Hb level in the presence of additional factors that deemed it unsafe to discharge them while waiting for Hb to increase. For example, 1 patient was admitted for 42 days for

Comment

Jehovah's Witness patients present a unique challenge to cardiac surgeons owing to their religious beliefs. Some surgeons may hesitate in providing requisite care to these patients because of these considerations, and because of the legal and ethical questions that may arise. In this study, we examine our outcomes for, often complex, cardiac surgical interventions in JW patients. We performed a variety of cardiac surgical procedures in this population. Ten patient (11.1%) required a redo

References (19)

There are more references available in the full text version of this article.

Cited by (0)

View full text