Division of Cardiovascular Surgery, University of Pennsylvania Medical Center, Pennsylvania Hospital, Philadelphia, Pennsylvania, USA.
Ann Thorac Surg. 2012 Jan;93(1):19-25. doi: 10.1016/j.athoracsur.2011.06.029. Epub 2011 Oct 5.
Cardiac surgery in Jehovah's Witnesses poses unique challenges. We have developed a comprehensive multimodality program for these patients and have obtained excellent results.
Ninety-one Jehovah's Witness patients underwent cardiac surgery between 2000 and 2010. Preoperative, intraoperative, and postoperative considerations in the conduct of bloodless surgery in the Jehovah's Witness population are discussed. Mortality for isolated coronary artery bypass graft surgery and isolated aortic valve replacement was compared with predicted mortality from The Society of Thoracic Surgeons (STS) risk models. Perioperative outcomes were stratified by urgent and elective status of operations.
Mean age was 65±12.4 years. Comorbid conditions included hypertension (84.6%), diabetes mellitus (48.4%), previous myocardial infarction (23.1%), chronic lung disease (38.5%), peripheral vascular disease (20.9%), and renal failure (11%). In-hospital mortality was 5.5% (n=5). Mortality for isolated coronary artery bypass graft surgery and isolated aortic valve replacement was 2.2% (observed to expected ratio=1.05, 95% confidence interval: 0 to 3.02) and 5.6% (observed to expected=1.46, 95% confidence interval: 0 to 3.76), respectively. Other complications included reoperation (all=8.8%, cardiac=2.2%), sepsis (2.2%), sternal wound infection (1.1%), transient ischemic attack (1.1%), renal failure requiring dialysis (1.1%), and prolonged ventilation (18.7%). Major complication rates were not significantly different between the elective group and the urgent group.
Bloodless cardiac surgery in Jehovah's Witness patients can be performed with excellent outcomes in both elective and urgent situations. Mortality rates for isolated coronary artery bypass graft surgery and isolated aortic valve replacement are within the expected 95% confidence intervals of STS predicted mortality.
在耶和华见证会信徒中进行心脏手术带来了独特的挑战。我们为这些患者制定了全面的多模式计划，并取得了优异的成果。
2000 年至 2010 年间，91 名耶和华见证会信徒接受了心脏手术。讨论了在耶和华见证会信徒中进行无血手术时的术前、术中及术后注意事项。孤立性冠状动脉旁路移植术和孤立性主动脉瓣置换术的死亡率与胸外科医师学会（STS）风险模型预测的死亡率进行了比较。根据手术的紧急和择期情况对围手术期结果进行分层。
平均年龄为 65±12.4 岁。合并症包括高血压（84.6%）、糖尿病（48.4%）、既往心肌梗死（23.1%）、慢性肺部疾病（38.5%）、外周血管疾病（20.9%）和肾衰竭（11%）。院内死亡率为 5.5%（n=5）。孤立性冠状动脉旁路移植术和孤立性主动脉瓣置换术的死亡率分别为 2.2%（观察到的死亡率与预期死亡率之比为 1.05，95%置信区间：0 至 3.02）和 5.6%（观察到的死亡率与预期死亡率之比为 1.46，95%置信区间：0 至 3.76）。其他并发症包括再次手术（均为 8.8%，心脏为 2.2%）、败血症（2.2%）、胸骨伤口感染（1.1%）、短暂性脑缺血发作（1.1%）、肾衰竭需要透析（1.1%）和长时间通气（18.7%）。择期组和急诊组的主要并发症发生率无显著差异。
在耶和华见证会信徒中进行无血心脏手术，无论是在择期还是急诊情况下，都可以取得极好的结果。孤立性冠状动脉旁路移植术和孤立性主动脉瓣置换术的死亡率均在 STS 预测死亡率的 95%置信区间内。
