Hartrumpf Martin, Kuehnel Ralf-Uwe, Ostovar Roya, Schroeter Filip, Albes Johannes M
Department of Cardiovascular Surgery, Heart Center Brandenburg, University Hospital Brandenburg Medical School (Theodor Fontane), Ladeburger Strasse 17, 16321 Bernau bei Berlin, Germany.
J Clin Med. 2023 Aug 3;12(15):5110. doi: 10.3390/jcm12155110.
Jehovah's Witnesses (JW) reject the transfusion of blood components based on their religious beliefs, even if they are in danger of harm or death. In cardiac surgery, this significantly reduces the margin of safety and leads to ethical conflicts. Informed consent should be carefully documented and the patient's family should be involved. This study aims to compare the postoperative course of JW who underwent major cardiac surgery with a similar population of non-Witnesses (NW).
Demographic, procedural, and postoperative data of all consecutive JW who underwent cardiac surgery at our institution were obtained from the records. They were compared with a propensity-score-matched group of NW. Anemic JW were treated with erythropoietin and/or iron as needed. Cardiac surgery was performed by experienced surgeons using median sternotomy and cardiopulmonary bypass. Common blood-sparing techniques were routinely used. Periprocedural morbidity and mortality were statistically evaluated for both groups.
A total of 32 JW and 64 NW were part of the matched dataset, showing no demographic or procedural differences. EPO was used preoperatively in 34.4% and postoperatively in 15.6% of JW but not in NW. Preoperative hemoglobin levels were similar (JW, 8.09 ± 0.99 mmol/L; NW, 8.18 ± 1.06; = 0.683). JW did not receive any transfusions except for one who revoked, while NW transfusion rates were 2.5 ± 3.1 units for red cells ( < 0.001) and 0.3 ± 0.8 for platelets ( = 0.018). Postoperative levels differed significantly for hemoglobin (JW, 6.05 ± 1.00 mmol/L; NW, 6.88 ± 0.87; < 0.001), and hematocrit (JW, 0.29 ± 0.04; NW, 0.33 ± 0.04; < 0.001) but not for creatinine. Early mortality was similar (JW, 6.3%; NW, 4.7%; = 0.745). There were more pacemakers and pneumonias in JW, while all other postoperative conditions were not different.
Real-world data indicate that Jehovah's Witnesses can safely undergo cardiac surgery provided that patients are preconditioned and treated by experienced surgeons who use blood-saving strategies. Postoperative anemia is observed but does not translate into a worse clinical outcome. This is consistent with other studies. Finally, the results of this study suggest that all patients should benefit from optimal pretreatment and blood-sparing strategies in cardiac surgery, not just Jehovah's Witnesses.
耶和华见证人（JW）基于其宗教信仰拒绝输血成分，即便处于伤害或死亡危险之中。在心脏手术中，这显著降低了安全边际并引发伦理冲突。应仔细记录知情同意情况，且应让患者家属参与其中。本研究旨在比较接受心脏大手术的JW与类似的非见证人（NW）人群的术后病程。
从记录中获取在我们机构接受心脏手术的所有连续JW的人口统计学、手术过程及术后数据。将他们与倾向得分匹配的NW组进行比较。贫血的JW根据需要接受促红细胞生成素和/或铁剂治疗。心脏手术由经验丰富的外科医生采用正中胸骨切开术和体外循环进行。常规使用常见的血液保护技术。对两组的围手术期发病率和死亡率进行统计学评估。
共有32名JW和64名NW纳入匹配数据集，两组在人口统计学或手术过程方面无差异。34.4%的JW在术前使用促红细胞生成素，15.6%在术后使用，而NW未使用。术前血红蛋白水平相似（JW，8.09±0.99 mmol/L；NW，8.18±1.06；P = 0.683）。除一名撤销拒绝输血的JW外，其他JW均未接受任何输血，而NW的红细胞输注率为2.5±3.1单位（P < 0.001），血小板输注率为0.3±0.8（P = 0.018）。术后血红蛋白水平（JW，6.05±1.00 mmol/L；NW, 6.88±0.87；P < 0.001）和血细胞比容（JW，0.29±0.04；NW，0.33±0.04；P < 0.001）差异显著，但肌酐水平无差异。早期死亡率相似（JW，6.3%；NW，4.7%；P = 0.745）。JW中起搏器植入和肺炎更多见，而其他所有术后情况无差异。
实际数据表明，只要患者经过预处理并由采用血液节约策略的经验丰富的外科医生进行治疗，耶和华见证人可以安全地接受心脏手术。术后贫血虽有观察到，但并未转化为更差的临床结局。这与其他研究一致。最后，本研究结果表明，所有患者都应从心脏手术中的最佳预处理和血液节约策略中获益，而不仅仅是耶和华见证人。
