Cardio-thoracic Department, S. Maria della Misericordia University Hospital, Udine, Italy.
J Cardiovasc Med (Hagerstown). 2010 Mar;11(3):170-4. doi: 10.2459/JCM.0b013e3283330752.
Surgical treatment of Jehovah's witnesses is a special challenge for cardiac surgery. The purpose of this study was to evaluate perioperative management and mid-term clinical outcome of Jehovah's witnesses who underwent cardiac surgery.
Between January 1990 and June 2009, 34 Jehovah's witnesses (22 men, mean age 66 +/- 8 years) underwent cardiac surgery. Surgical procedures included 17 coronary artery bypass grafts (CABG): 3 CABG and aortic valve replacements (AVR); 1 CABG and mitral valve plasty (MVP); 6 AVR; 1 subaortic membrane resection; 2 mitral valve replacements (MVR) and 2 MVP; 1 mitro-aortic valve replacement; and 1 cardiac foreign body removal. There were four urgent operations; 14 patients had NYHA class II-III. Sixteen patients received erythropoietin preoperatively. Preoperative haemoglobin (Hb) value was 14.2 +/- 1.4 g/dl.
Extracorporeal circulation time was 127 +/- 66 min, aortic cross-clamping 84 +/- 45 min. Haemoglobin value 24 h after surgery was 11.2 +/- 1.7 g/dl, haematocrit 34.1 +/- 5.2%. None required surgical reoperation for bleeding.Intensive care unit stay was 2.3 +/- 4.3 days, hospital stay 12.3 +/- 10.4 days; there was no hospital mortality. Postoperatively, erythropoietin was administered to 19 patients. Follow-up was completed in 100%. Reoperation was necessary 8 years later in one patient for mitral bioprosthesis degeneration; the patient died 8 months later. All other patients are alive 59 +/- 60 months after surgery; actuarial survival is 100% and 80 +/- 2% at 5 and 10 years, respectively.
In our limited experience, early and late surgical results of Jehovah's witnesses patients are satisfactory. Appropriate preoperative management, optimization of Hb values, intraoperative measures to reduce the risk of bleeding and total blood loss recovery are the goals to achieve these results.
对耶和华见证人进行外科手术治疗是心脏外科的一项特殊挑战。本研究的目的是评估接受心脏手术的耶和华见证人的围手术期管理和中期临床结果。
1990 年 1 月至 2009 年 6 月期间，34 名耶和华见证人（22 名男性，平均年龄 66 +/- 8 岁）接受了心脏手术。手术包括 17 例冠状动脉旁路移植术（CABG）：3 例 CABG 和主动脉瓣置换术（AVR）；1 例 CABG 和二尖瓣成形术（MVP）；6 例 AVR；1 例主动脉下膜切除术；2 例二尖瓣置换术（MVR）和 2 例 MVP；1 例二尖瓣-主动脉瓣置换术；1 例心脏异物取出术。有 4 例紧急手术；14 例患者 NYHA 心功能分级 II-III 级。16 例患者术前接受了促红细胞生成素治疗。术前血红蛋白（Hb）值为 14.2 +/- 1.4 g/dl。
体外循环时间为 127 +/- 66 分钟，主动脉阻断时间为 84 +/- 45 分钟。术后 24 小时 Hb 值为 11.2 +/- 1.7 g/dl，血细胞比容 34.1 +/- 5.2%。无因出血再次手术。重症监护病房停留时间为 2.3 +/- 4.3 天，住院时间为 12.3 +/- 10.4 天；无院内死亡。术后 19 例患者接受了促红细胞生成素治疗。随访完成率为 100%。1 例患者 8 年后因二尖瓣生物瓣退行性变需再次手术，患者 8 个月后死亡。所有其他患者术后 59 +/- 60 个月均存活；术后 5 年和 10 年的生存率分别为 100%和 80 +/- 2%。
在我们有限的经验中，耶和华见证人的早期和晚期手术结果令人满意。适当的术前管理、优化 Hb 值、术中减少出血风险和总失血量恢复是实现这些结果的目标。
