Cardiac surgery with cardiopulmonary bypass in Jenovah’s witness patients
Dong-san Medical Center, Keimyung University, Daegu, Korea, Republic of.
OBJECTIVE: Cardiac surgery in Jenovah’s witness patients has many limitations because of refusal of blood transfusion. We evaluated perioperative outcomes of cardiac surgery with cardiopulmonary bypass.
METHODS: From January 1997 to July 2011, 118 Jenovah’s witness patients underwent cardiac surgery with cardiopulmonary bypass without blood transfusion. From the earlier study period, we have conducted the blood conservative program including preoperative, intraoperative and postoperative management. We reviewed perioperative clinical outcomes, and various perioperative data were statistically analyzed to determine risk factors for postoperative complications.
RESULTS: The median age was 40.5 years (interquartile range, 8.0 - 56.3). There were two emergent operations and 17 redo-operations. Cardiac surgeries included ASD (n = 19), VSD (n = 19), TOF total correction (n = 4), valve replacement (n = 36), valve repair (n = 11), CABG (n = 13), myxoma removal (n = 4), aortic root replacement (n = 3), and others. The operative mortality was 3.4% (n = 4). Postoperative values of hematocrit (34.7%) and hemoglobin (11.5g/dl) were significantly lower than preoperative values of hematocrit (39.4%) and hemoglobin (13.2g/dl) (p < 0.000). The mean value of lowest hematocrit during cardiopulmonary bypass was 22.3% ± 3.5%. Postoperative complications included acute renal insufficiency (n = 6), mediastinitis (n = 6), LV dysfunction (n = 3), thromboembolism (n = 2), intractable arrhythmia (n = 2), pericardiostomy (n = 2), and others. In multivariate logistic regression analysis, previous operation (odds ratio, 8.062; p = 0.007) and difference of preoperative and postoperative ejection fraction (odds ratio, 0.384; p =0.017) were identified as significant independent risk factors for postoperative complications.
CONCLUSIONS: Perioperative hemotologic diminution seems no longer a matter of grave concern regarding postoperative complications in Jenovah’s witness patient under well-designed blood conservative program.
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