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Permanent URL to this publication: http://dx.doi.org/10.5167/uzh-36207

Emmert, M Y; Salzberg, S P; Theusinger, O M; Felix, C; Plass, A; Hoerstrup, S P; Falk, V; Grünenfelder, J (2010). How good patient blood management leads to excellent outcomes in Jehovah's witness patients undergoing cardiac surgery. Interactive Cardiovascular and Thoracic Surgery, 12(2):183-188.

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Objectives: The refusal of blood products makes open-heart surgery in Jehovah's Witness (JW) an ethical challenge. We demonstrate how patient blood management strategies lead to excellent surgical outcomes. Methods: From 2003 to 2008, 16 JW underwent cardiac surgery at our institution. Only senior surgeons performed coronary revascularization (n=6), valve (n=6), combined (n=1) and aortic surgery (n=3) of which two patients presented with acute type-A dissection. Off-pump surgery remained the method of choice for patients requiring a bypass procedure (n=5). Preoperative hematocrit (Hk) and hemoglobin (Hb) were 42.8±4.7% and 14.5±2 g/dl. In three patients with an Hb<12 g/dl, preoperative hematological stimulating treatment was implemented. Results: All patients survived, no major complications occurred and no blood transfusion was administered. The Cell Saver® system (transfused volume: 474±101 ml) and synthetic plasma substitutes [Ringer's Lactate: 873±367 ml and hydroxyethyl starch (HES) 6%: 700±388 ml] were used routinely as well as hemostaticas, such as bone wax, and fibrin glue. The decrease of Hk and Hb appeared to be the lowest after off-pump surgery when compared to all other procedures requiring cardiopulmonary bypass (CPB) (25±9% vs. 33±6%; P=0.01 and 22±9% vs. 31±6%; P=0.04). Similarly, the decrease of platelets was significantly lower (20±12% vs. 43±14%; P=0.01). In the follow-up period (52±34 months), one patient died due to a non-cardiac reason, whereas all others were alive, in good clinical condition and did not have major adverse cardiac events (MACE) or recurrent symptoms requiring re-intervention. Conclusion: Patient blood management leads to excellent short- and long-term outcomes in JW. Combined efforts in regard to preoperative hematological parameter optimization, effective volume management and meticulous surgical techniques make this possible but raise the cautionary note why this is only possible in JW patients.


23 citations in Web of Science®
28 citations in Scopus®
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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiovascular Surgery
04 Faculty of Medicine > University Hospital Zurich > Division of Surgical Research
04 Faculty of Medicine > University Hospital Zurich > Institute of Anesthesiology
04 Faculty of Medicine > Center for Medical Research
Dewey Decimal Classification:570 Life sciences; biology
610 Medicine & health
Deposited On:15 Nov 2010 12:26
Last Modified:05 Apr 2016 14:16
Publisher:European Association of Cardio-Thoracic Surgery
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:10.1510/icvts.2010.242552
PubMed ID:20829389

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