title: Mid-term clinical outcomes in cardiac surgery of Jehovah's witnesses.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Cardio-thoracic Department, S. Maria della Misericordia University Hospital, Udine, Italy. pompei.esmeralda@aoud.sanita.fvg.it
authors.forename: Esmeralda
authors.initials: E
authors.lastname: Pompei
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Tursi
authors.forename: Giorgio
authors.initials: G
authors.lastname: Guzzi
authors.forename: Igor
authors.initials: I
authors.lastname: Vendramin
authors.forename: Fabio
authors.initials: F
authors.lastname: Ius
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Muzzi
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Auci
authors.forename: Luigi Paolo
authors.initials: LP
authors.lastname: Badano
authors.forename: Ugolino
authors.initials: U
authors.lastname: Livi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D003422:Critical Care; D004921:Erythropoietin / Q000008:administration & dosage; D005260:Female; D006397:Hematinics / Q000008:administration & dosage; D006400:Hematocrit; D006454:Hemoglobins / Q000378:metabolism; D006488:Hemostasis, Surgical; D006801:Humans; D007558:Italy; D033221:Jehovah's Witnesses; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D012068:Religion and Medicine; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D016312:Treatment Refusal
chemical_list: D006397:Hematinics; D006454:Hemoglobins; D004921:Erythropoietin