Open-heart surgery in Jehovah’s witnesses. A propensity score analysis

Abstract Background Jehovah’s Witnesses (JW) refuse allogeneic blood transfusions and pose therefore a unique challenge in case of major surgery. In the present retrospective study we review our experience with JW patients undergoing open-heart surgery. Methods By using patient blood management (PBM) strategies, 35 adult JW patients underwent cardiac surgery at our institution between 2008 and 2017. Outcomes were compared to patients who accepted blood transfusions (non-JW patients) using propensity score matching. Results There were no significant differences in clinical and operative data between groups. Twelve JW patients (34.3%) were pretreated with erythropoietin/iron, with a preoperative increase in mean hemoglobin by 2.0 g/dl. On admission, hemoglobin was 14.1 ± 1.1 g/dl in JW patients, compared to 13.2 ± 2.0 g/dl in non-JW patients (p=0.022). The hematocrit in JW patients was higher throughout the hospital stay, despite 51.4% of non-JW patients received allogeneic red blood cell (RBC) transfusions. The perioperative RBC loss was significantly lower in JW patients than in non-JW patients (619 ± 420 vs. 929 ± 520 ml; p=0.010). Major complication rates were not different between groups. The hemoglobin at discharge was 11.5 ± 1.5 g/dl in JW patients compared to 10.3 ± 1.3 g/dl in non-JW patients (p Conclusions By implementing PBM, open-heart surgery in JW patients can be performed with a low morbidity and mortality. Preoperative optimization of hemoglobin and minimization of perioperative blood loss are cornerstones in the prevention of blood loss, anemia and transfusions.