THE JOURNAL OF CARDIOVASCULAR SURGERY

A Journal on Cardiac, Vascular and Thoracic Surgery

Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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The Journal of Cardiovascular Surgery 2018 Apr 03

DOI: 10.23736/S0021-9509.18.10335-1

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Short-term outcome of cardiac surgery under cardiopulmonary bypass in patients who refuse transfusion: a controlled study

Antonio REYES GARCIA ✉, Gema VEGA GONZÁLEZ ¹, Ricardo ANDINO RUIZ

Intensive Care Unit, Hospital Universitario de la Princesa, Instituto de Investigación La Princesa, Madrid, Spain

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BACKGROUND: Although bloodless cardiac surgery has been successfully performed for many years, studies with controls permitting transfusion are few and their results inconclusive. This study compares the outcome of cardiac surgery on Jehovah’s Witnesses (JW) refusing transfusion, with that of controls permitting transfusion if required.
METHODS: Data from 172 operations in 162 JW were compared with 172 matched controls. Risk factors, preoperative, operative, 48 hour postoperative variables, outcome data and transfusions were recorded.
RESULTS: Preoperative and operative variables were similar in both groups except for more previous cardiac operations, and more frequent use of cell saver and aprotinin in JW, who bled less and had higher haemoglobin concentrations at all periods. Thirty-day mortality was higher in JW (9.9% vs 3.5%; p = 0.03) (Risk difference 6.4%; CI95%: 2.7-10.1). Nevertheless operative mortality was similar in both groups (9.9% vs 7.6%; p = 0.44). Mortality in low-risk subjects was higher in JW (8.9% vs 1.0%; p = 0.02) (Risk difference 7.9%; CI95%: 2.7-13.2). Moreover, death associated with haemorrhage and anaemia tended to be more frequent in JW. Mortality of transfused controls (14.1%) and their matched JW (13.0%) was similar. In contrast, mortality of non-transfused controls was zero versus 6.3% in their matched JW (p = 0.059).
CONCLUSIONS: Low-risk JW had significantly higher mortality than controls. Bleeding related deaths tended to be more frequent in JW. Blood-sparing manoeuvres should be intensively implemented in both JW and patients permitting transfusion in order to reduce bleeding and the need for transfusion with its harmful effects.

KEY WORDS: Bloodless cardiac surgery - Jehovah’s witnesses - Outcome after cardiac surgery - Blood transfusion - Postoperative bleeding - Mortality - Risk