Moraca Robert J, Wanamaker Kelly M, Bailey Stephen H, McGregor Walter E, Benckart Daniel H, Maher Thomas D, Magovern George J
Department of Cardiovascular and Thoracic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania 15212, USA.
J Card Surg. 2011 Mar;26(2):135-43. doi: 10.1111/j.1540-8191.2011.01215.x. Epub 2011 Feb 23.
Jehovah's Witnesses (JW) are a Christian faith, with an estimated 1.1 million members in the United States, well recognized for their refusal of blood and blood products. JW may not be considered for cardiac surgery due to perceived higher risks of morbidity and mortality. This study reviews our contemporary strategies and experience with JW undergoing routine and complex cardiac surgery.
From November 2001 to April 2010, 40 JW were referred for cardiac surgery at a single quaternary referral institution. A retrospective analysis of demographic data, perioperative management, and clinical outcomes was examined. Published validated clinical risk calculator and model for prediction of transfusion were used to identify high-risk patients (risk of mortality >6% or probability of transfusion >0.80).
The mean age was 70 (± 9.5) years with 21 men and 19 women. Patients were classified as high risk (45%, n = 18) and low risk (55%, n = 22) with demographics and comorbidities listed in Table 2. Operative procedures included: isolated coronary artery bypass grafting (CABG) (n = 19), isolated valve replacement/repair (n = 7), valve/CABG (n = 7), reoperative valve replacement (n = 4), reoperative CABG (n = 2), valve/ascending aorta replacement (n = 1), and CABG/ascending aorta replacement (n = 1). All JW were evaluated by The Department of Bloodless Medicine to individually define acceptable blood management strategies. The mean preoperative hemoglobin was 14.1 g/dL (±1.6). Overall mortality was 5% (n = 2) all of which were in the high-risk group.
Using a multidisciplinary approach to blood management, JW can safely undergo routine and complex cardiac surgery with minimal morbidity and mortality.
耶和华见证人是一个基督教教派，在美国估计有110万成员，因其拒绝接受血液及血液制品而广为人知。由于被认为存在较高的发病和死亡风险，耶和华见证人可能不被考虑进行心脏手术。本研究回顾了我们在耶和华见证人接受常规和复杂心脏手术方面的当代策略和经验。
从2001年11月至2010年4月，40名耶和华见证人被转诊至一家单一的四级转诊机构进行心脏手术。对人口统计学数据、围手术期管理和临床结果进行了回顾性分析。使用已发表的经过验证的临床风险计算器和输血预测模型来识别高危患者（死亡风险>6%或输血概率>0.80）。
平均年龄为70（±9.5）岁，男性21例，女性19例。根据表2中列出的人口统计学和合并症，患者被分为高危（45%，n = 18）和低危（55%，n = 22）。手术操作包括：单纯冠状动脉旁路移植术（CABG）（n = 19）、单纯瓣膜置换/修复术（n = 7）、瓣膜/CABG术（n = 7）、再次瓣膜置换术（n = 4）、再次CABG术（n = 2）、瓣膜/升主动脉置换术（n = 1）和CABG/升主动脉置换术（n = 1）。所有耶和华见证人都由无血医学部进行评估，以单独确定可接受的血液管理策略。术前平均血红蛋白为每分升14.1克（±1.6）。总体死亡率为5%（n = 2），均在高危组。
采用多学科方法进行血液管理，耶和华见证人可以安全地接受常规和复杂的心脏手术，发病率和死亡率最低。
