title: Strategies and outcomes of cardiac surgery in Jehovah's Witnesses.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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).
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Using a multidisciplinary approach to blood management, JW can safely undergo routine and complex cardiac surgery with minimal morbidity and mortality.
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania 15212, USA. rmoraca@wpahs.org
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Moraca
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Wanamaker
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Bailey
authors.forename: Walter E
authors.initials: WE
authors.lastname: McGregor
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Benckart
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Maher
authors.forename: George J
authors.initials: GJ
authors.lastname: Magovern
mesh_terms: D000368:Aged; D001803:Blood Transfusion; D006348:Cardiac Surgical Procedures / Q000379:methods / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000523:psychology / Q000601:surgery*; D006801:Humans; D033221:Jehovah's Witnesses / Q000523:psychology*; D008297:Male; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States