Cardiac Surgery and Jehovah’s witness patients
Witness patients undergoing cardiac surgery is not without risk,
primarily due to this surgery carrying an increased association with
bleeding and the inability to transfuse blood products. In 1964, open
heart surgery using cardiopulmonary bypass (CPB) on Witnesses was first
described, made possible by the development of bypass
techniques13. Witnesses are often not considered for
cardiac surgery due to the increased risk of morbidity and mortality,
with early research demonstrating a mortality rate of
7-10%14. This perceived risk is affected by the
population being referred for cardiac surgery; at later stages in life,
with multiple comorbidities, and often the use of new
anticoagulants4. As research has evolved, there has
been a decrease in mortality rates demonstrated by a range of larger
studies15,16; whether this is due to improvements in
blood management strategy, technology advances, or careful patient
selection is unclear. The majority of these findings are limited to
adults, however research has now been extended to include infants and
children, highlighting similar results and emphasising the need for more
liberal, instead of restrictive, transfusion
strategy17,18. Greater complications arise when the
size of the patient is taken into consideration18,
largely due to the resultant increase in haemodilution from CPB prime
volume to the circulating blood volume of neonates and
infants17,19. However, Olshove et al.demonstrated that bloodless cardiac surgery is feasible for this
population if a comprehensive blood conservation program is
adopted20. This can be achieved through careful
discussion and a thorough understanding of the patients’ beliefs at the
pre-operative stage. This is particularly important to comprehend
because not all Witness patients hold identical beliefs and the exact
level of acceptance of blood product usage lies with each individual, as
discussed below.