title: Perioperative Management of a Child with Hypoplastic Left Heart Syndrome of the Jehovah's Witness Faith Presenting for Hybrid Comprehensive Stage II Procedure.
abstract: Over the years, there has been a growing recognition of the potential negative sequelae of allogeneic blood products on postoperative outcomes following cardiac surgery. In addition, followers of the Jehovah's Witness (JW) faith have a religious restriction against receiving blood or blood components. Advances in perioperative care, cardiopulmonary bypass (CPB), and surgical technique have minimized the need for allogeneic blood products. Specific blood conservation strategies include maximizing the preoperative hematocrit and coagulation function as well as intraoperative strategies, such as acute normovolemic hemodilution and adjustments of the technique of CPB. We report a 7-month-old patient whose parents were of the JW faith who underwent a comprehensive stage II procedure for hypoplastic left heart syndrome without exposure to blood or blood products during his hospital stay. Perioperative techniques for blood avoidance are discussed with emphasis on their application to infants undergoing surgery for congenital heart disease.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Sathappan
authors.initials: S
authors.lastname: Karuppiah
authors.affiliation: Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.; Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio.
authors.forename: Christopher
authors.initials: C
authors.lastname: Mckee
authors.affiliation: The Heart Center, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Ashley
authors.initials: A
authors.lastname: Hodge
authors.affiliation: The Heart Center, Nationwide Children's Hospital, Columbus, Ohio.; Department of Cardiothoracic, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Mark
authors.initials: M
authors.lastname: Galantowicz
authors.affiliation: Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.; Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio.
authors.forename: Joseph
authors.initials: J
authors.lastname: Tobias
authors.affiliation: Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.; Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio.
authors.forename: Aymen
authors.initials: A
authors.lastname: Naguib
mesh_terms: D057668:Bloodless Medical and Surgical Procedures / Q000941:ethics* / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000941:ethics* / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000941:ethics / Q000379:methods; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000175:diagnosis / Q000628:therapy*; D007231:Infant, Newborn; D033221:Jehovah's Witnesses; D008297:Male; D033282:Parental Consent / Q000941:ethics*; D016896:Treatment Outcome
keywords: Jehovah's Witness, cardiac surgery; acute normovolemic hemodilution; bloodless pediatric surgery; bloodless surgery; pediatric cardiac surgery; retrograde autologous prime; venous antegrade prime