Abstract
Jehovah’s Witnesses (JW) are well recognized for their refusal of blood products as part of their faith. Cardiac surgery is associated with relatively high demand for blood transfusion making it challenging to perform cardiac surgery in JW patients. The first case of cardiac surgery in a JW patient was reported in 1964. Since then, blood management strategies have evolved including preoperative optimization of hemoglobin level, new pharmacological agents, and improved cardiopulmonary bypass systems. Currently, cardiac surgery in JW patients including even high-risk complex cases can be safely performed with those blood management strategies. Recently clinical outcomes in cardiac surgery in JW patients have become comparable to those of non-JW patients in a selected patient group. There are many positive effects by avoiding blood transfusion such as risks of blood-transmitted infection. Therefore, the blood management strategies developed for JW patients would be beneficial to any cardiac surgery patients. In this chapter, current blood management strategies in cardiac surgery of JW patients will be discussed.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
2017 year book of Jehovah’s witnesses. Warwick: Watchtower Bible and Tract Society of NY Inc; 2017.
Cooley DA, Crawford ES, Howell JF, Beall AC Jr. Open heart surgery in Jehovah’s Witnesses. Am J Cardiol. 1964;13:779–81.
Zaorski JR, Hallman GL, Cooley DA. Open heart surgery for acquired heart disease in Jehovah’s Witnesses. A report of 42 operations. Am J Cardiol. 1972;29:186–9.
Chiariello L, Sandiford FM, Cooley DA. Aortocoronary bypass in Jehovah’s Witnesses: results in 36 patients. Cardiovasc Dis. 1974;1:87–94.
Ott DA, Cooley DA. Cardiovascular surgery in Jehovah’s Witnesses. Report of 542 operations without blood transfusion. JAMA. 1977;238:1256–8.
Tanaka A, Ota T, Uriel N, et al. Cardiovascular surgery in Jehovah’s Witness patients: the role of preoperative optimization. J Thorac Cardiovasc Surg. 2015;150:976–83.
Marshall L, Krampl C, Vrtik M, et al. Short term outcomes after cardiac surgery in a Jehovah’s Witness population: an institutional experience. Heart Lung Circ. 2012;21:101–4.
Emmert MY, Salzberg SP, Theusinger OM, et al. How good patient blood management leads to excellent outcomes in Jehovah’s witness patients undergoing cardiac surgery. Interact Cardiovasc Thorac Surg. 2011;12:183–8.
McCartney S, Guinn N, Roberson R, et al. Jehovah’s Witnesses and cardiac surgery: a single institution’s experience. Transfusion. 2014;54:2745–52.
Pompei E, Tursi V, Guzzi G, et al. Mid-term clinical outcomes in cardiac surgery of Jehovah’s witnesses. J Cardiovasc Med (Hagerstown). 2010;11:170–4.
Vaislic CD, Dalibon N, Ponzio O, et al. Outcomes in cardiac surgery in 500 consecutive Jehovah’s Witness patients: 21 year experience. J Cardiothorac Surg. 2012;7:95.
Moraca RJ, Wanamaker KM, Bailey SH, et al. Strategies and outcomes of cardiac surgery in Jehovah’s Witnesses. J Card Surg. 2011;26:135–43.
Jassar AS, Ford PA, Haber HL, et al. Cardiac surgery in Jehovah’s Witness patients: ten-year experience. Ann Thorac Surg. 2012;93:19–25.
Pattakos G, Koch CG, Brizzio ME, et al. Outcome of patients who refuse transfusion after cardiac surgery. Arch Intern Med. 2012;172:1154–60.
Guinn NR, Roberson RS, White W, et al. Costs and outcomes after cardiac surgery in patients refusing transfusion compared with those who do not: a case-matched study. Transfusion. 2015;55:2791–8.
El Azab SR, Vrakking R, Verhage G, et al. Safety of cardiac surgery without blood transfusion: a retrospective study in Jehovah’s Witness patients. Anaesthesia. 2010;65:348–52.
Stamou SC, White T, Barnett S, et al. Comparisons of cardiac surgery outcomes in Jehovah’s versus Non-Jehovah’s Witnesses. Am J Cardiol. 2006;98:1223–5.
Reyes G, Nuche JM, Sarrai A, et al. Bloodless cardiac surgery in Jehovah’s witnesses: outcomes compared with a control group. Rev Esp Cardiol. 2007;60:727–31.
Vaislic C, Bical O, Farge C, et al. Totally minimized extracorporeal circulation: an important benefit for coronary artery bypass grafting in Jehovah’s witnesses. Heart Surg Forum. 2003;6:307–10.
Bhaskar B, Jack RK, Mullany D, et al. Comparison of outcome in Jehovah’s Witness patients in cardiac surgery: an Australian experience. Heart Lung Circ. 2010;19:655–9.
Marinakis S, Van der Linden P, Tortora R, et al. Outcomes from cardiac surgery in Jehovah’s witness patients: experience over twenty-one years. J Cardiothorac Surg. 2016;11:67.
Bennett-Guerrero E, Zhao Y, O'Brien SM, et al. Variation in use of blood transfusion in coronary artery bypass graft surgery. JAMA. 2010;304:1568–75.
Ranucci M, Baryshnikova E, Castelvecchio S, et al. Major bleeding, transfusions, and anemia: the deadly triad of cardiac surgery. Ann Thorac Surg. 2013;96:478–85.
Miceli A, Romeo F, Glauber M, de Siena PM, et al. Preoperative anemia increases mortality and postoperative morbidity after cardiac surgery. J Cardiothorac Surg. 2014;9:137.
Cladellas M, Farré N, Comín-Colet J, et al. Effects of preoperative intravenous erythropoietin plus iron on outcome in anemic patients after cardiac valve replacement. Am J Cardiol. 2012;110:1021–6.
Gaudiani VA, Mason DW. Preoperative erythropoietin in Jehovah’s Witnesses who require cardiac procedures. Ann Thorac Surg. 1991;51:823–4.
Weltert L, Rondinelli B, Bello R, et al. A single dose of erythropoietin reduces perioperative transfusions in cardiac surgery: results of a prospective single-blind randomized controlled trial. Transfusion. 2015;55:1644–54.
Spahn DR, Goodnough LT. Alternatives to blood transfusion. Lancet. 2013;381:1855–65.
Yu L, Gu T, Song E, et al. Fibrin sealant provides superior hemostasis for sternotomy compared with bone wax. Ann Thorac Surg. 2012;93:641–4.
Henderson AM, Maryniak JK, Simpson JC. Cardiac surgery in Jehovah’s witnesses. A review of 36 cases. Anaesthesia. 1986;41:748–53.
Mahmood S, Bilal H, Zaman M, et al. Is a fully heparin-bonded cardiopulmonary bypass circuit superior to a standard cardiopulmonary bypass circuit? Interact Cardiovasc Thorac Surg. 2012;14:406–14.
Rubens FD, Boodhwani M, Mesana T, et al. The cardiotomy trial: a randomized, double-blind study to assess the effect of processing of shed blood during cardiopulmonary bypass on transfusion and neurocognitive function. Circulation. 2007;116:I89–97.
Boodhwani M, Hamilton A, de Varennes B, et al. A multicenter randomized controlled trial to assess the feasibility of testing modified ultrafiltration as a blood conservation technology in cardiac surgery. J Thorac Cardiovasc Surg. 2010;139:701–6.
Richmond ME, Charette K, Chen JM, et al. The effect of cardiopulmonary bypass prime volume on the need for blood transfusion after pediatric cardiac surgery. J Thorac Cardiovasc Surg. 2013;145:1058–64.
Fromes Y, Gaillard D, Ponzio O, et al. Reduction of the inflammatory response following coronary bypass grafting with total minimal extracorporeal circulation. Eur J Cardiothorac Surg. 2002;22:527–33.
John A, Bennett M, Lloyd C, et al. Overcoming challenges: the use of minimal extracorporeal circulation in Jehovah’s Witnesses undergoing cardiac surgery. J Thorac Cardiovasc Surg. 2010;139:e122–3.
Vasques F, Kinnunen EM, Pol M, et al. Outcome of Jehovah’s Witnesses after adult cardiac surgery: systematic review and meta-analysis of comparative studies. Transfusion. 2016;56:2146–53.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Kitahara, H., Ota, T., Jeevanandam, V. (2019). Complex Cardiac Surgery Without Blood Transfusions: Lessons Learned from Managing Jehovah Witness Patients. In: Lonchyna, V. (eds) Difficult Decisions in Cardiothoracic Critical Care Surgery. Difficult Decisions in Surgery: An Evidence-Based Approach. Springer, Cham. https://doi.org/10.1007/978-3-030-04146-5_34
Download citation
DOI: https://doi.org/10.1007/978-3-030-04146-5_34
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-04145-8
Online ISBN: 978-3-030-04146-5
eBook Packages: MedicineMedicine (R0)