title: Outcomes in cardiac surgery in 500 consecutive Jehovah's Witness patients: 21 year experience.
abstract: BACKGROUND
  Refusal of heterogenic blood products can be for religious reasons as in Jehovah's Witnesses or otherwise or as requested by an increasing number of patients. Furthermore blood reserves are under continuous demand with increasing costs. Therefore, transfusion avoidance strategies are desirable. We describe a historic comparison and current results of blood saving protocols in Jehovah's Witnesses patients.
  
  
  METHODS
  Data on 250 Jehovah's Witness patients operated upon between 1991 and 2003 (group A) were reviewed and compared with a second population of 250 patients treated from 2003 to 2012 (group B).
  
  
  RESULTS
  In group A, mean age was 51 years of age compared to 68 years in group B. An iterative procedure was performed in 13% of patients in group B. Thirty days mortality was 3% in group A and 1% in group B despite greater operative risk factors, with more redo, and lower ejection fraction in group B. Several factors contributed to the low morbidity-mortality in group B, namely: preoperative erythropoietin to attain a minimal hemoglobin value of 14 g/dl, warm blood cardioplegia, the implementation of the Cornell University protocol and fast track extubation.
  
  
  CONCLUSIONS
  Cardiac surgery without transfusion in high-risk patients such as Jehovah Witnesses can be carried out with results equivalent to those of low risk patients. Recent advances in surgical techniques and blood conservation protocols are main contributing factors.
authors.affiliation: CHP PARLY 2, 21 Rue Moxouris, Le Chesnay, 78150, France. claudevaislic@hotmail.com
authors.forename: Claude D
authors.initials: CD
authors.lastname: Vaislic
authors.forename: Nicolas
authors.initials: N
authors.lastname: Dalibon
authors.forename: Oliver
authors.initials: O
authors.lastname: Ponzio
authors.forename: Maguette
authors.initials: M
authors.lastname: Ba
authors.forename: Eric
authors.initials: E
authors.lastname: Jugan
authors.forename: Franck
authors.initials: F
authors.lastname: Lagneau
authors.forename: Philippe
authors.initials: P
authors.lastname: Abbas
authors.forename: Yves
authors.initials: Y
authors.lastname: Olliver
authors.forename: Didier
authors.initials: D
authors.lastname: Gaillard
authors.forename: Francois
authors.initials: F
authors.lastname: Baget
authors.forename: Michel
authors.initials: M
authors.lastname: Sportiche
authors.forename: Antoine
authors.initials: A
authors.lastname: Chedid
authors.forename: Georges
authors.initials: G
authors.lastname: Chaoul
authors.forename: Philippe
authors.initials: P
authors.lastname: Maribas
authors.forename: Christiane
authors.initials: C
authors.lastname: Dupuy
authors.forename: Bruno
authors.initials: B
authors.lastname: Robine
authors.forename: Nicolas
authors.initials: N
authors.lastname: Kasanin
authors.forename: Herve
authors.initials: H
authors.lastname: Michon
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Ruat
authors.forename: Michel
authors.initials: M
authors.lastname: Habis
authors.forename: Touhami
authors.initials: T
authors.lastname: Bouharaoua
mesh_terms: D000328:Adult; D000368:Aged; D057668:Bloodless Medical and Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data*; D006348:Cardiac Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D033221:Jehovah's Witnesses; D008297:Male; D008875:Middle Aged; D009026:Mortality; D012307:Risk Factors; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D006454:Hemoglobins