Minimized perfusion circuits: an alternative in the surgical treatment of Jehovah's Witnesses.
OBJECTIVE
Jehovah's Witnesses present a challenge to cardiac surgeons, as quality of care is not only defined by mortality and morbidity, but also by the avoidance of blood transfusions. Over the last years, minimized perfusion circuits (MPC) have contributed substantially to the achievement of this goal in our clinic. Presented is a retrospective analysis of our experience.


METHODS
Twenty-nine Jehovah's Witnesses, aged 69 ± 10 years, have undergone cardiac surgery with a MPC in our institution since 2005. The ROCsafe (reservoir optional circuit) MPC was used in most of these patients (n=27) as it offers the unique possibility of a speedy integration of a reservoir in the event of a major air leak, thereby, negligating any safety concerns.


RESULTS
There was no in-hospital or 30-day postoperative mortality. Mean ICU stay was 1.6 ± 2 days with a mean intubation time of 11.3 ± 9.1 hrs. Postoperative complications included one myocardial infarction with accompanying low cardiac output, one stroke, one transient delirium, one idiopathic thrombocytopenia and three re-operations (one sternal infection, one postoperative bleeding and one delayed tamponade). The mean postoperative hospital stay was 9.9 ± 2.3 days. Mean decrease in hemoglobin was 2.1 ± 1.3 g/dl during cardiopulmonary bypass and 3.4 ±1.4 g/dl at discharge. The lowest postoperative hemoglobin level was 9.3 ±1.8 (Range 6-12.9).


CONCLUSIONS
These encouraging results emphasize the role MPCs can play in optimizing the quality of patient care. We hope that this report can serve as a stimulus for similar experiences.
Klinikum Braunschweig, Department of Thoracic and Cardiovascular Surgery, Braunschweig, Germany. aelessawi@aol.com
A
A
El-Essawi
I
I
Breitenbach
K
K
Ali
P
P
Jungebluth
R
R
Brouwer
M
M
Anssar
W
W
Harringer
D000368:Aged; D001803:Blood Transfusion / Q000295:instrumentation* / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006801:Humans; D033221:Jehovah's Witnesses; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D012189:Retrospective Studies