Short and long-term outcomes after cardiac surgery in Jehovah's Witnesses patients: a case-control study.
Bloodless surgery
Cardiac surgery
Complications
Heart failure
Jehovah’s Witnesses
Patient blood management
Transfusion
Journal
Internal and emergency medicine
ISSN: 1970-9366
Titre abrégé: Intern Emerg Med
Pays: Italy
ID NLM: 101263418
Informations de publication
Date de publication:
01 2023
01 2023
Historique:
received:
09
07
2022
accepted:
17
10
2022
pubmed:
20
11
2022
medline:
1
2
2023
entrez:
19
11
2022
Statut:
ppublish
Résumé
Cardiac surgery in Jehovah's Witnesses (JW) patients who refuse blood transfusion is challenging requiring dedicated strategies. We aimed to analyze non-selected JW patients undergoing cardiac surgery and to compare with matched controls both perioperative outcomes and long-term survival. We retrospectively analyzed JW patients undergoing cardiac surgery from January 2016 to March 2021 and compared them with matched controls. The primary outcome was a composite of in-hospital perioperative adverse events and in-hospital mortality. The secondary outcome was all-cause mortality at long-term follow-up. A total of 113 JW patients and 113 controls were included. Baseline clinical characteristics, including laboratory parameters were comparable. Overall, there were no statistical differences between JW vs controls in terms of in-hospital mortality (2.7% vs 1.8%, p = 1.00) but mortality was remarkably high (40%) in JW patients with post-op hemoglobin < 8 g/dl. Logistic regression analysis found that the JW group was not associated with a higher occurrence of the composite outcome (adjusted odds ratio 0.91, 95% confidence interval [CI] 0.54-1.57). After a median follow-up of 1397 [IQR 922.7-1723.5] days, JW patients were not associated with a significantly higher all-cause mortality (adjusted hazard ratio 0.77, 95% CI 0.24-2.42). Cardiac surgery can be safely performed in non-anemic JW patients despite the refusal of blood transfusions. Favorable clinical outcomes can be achieved by the use of specific perioperative strategies for bloodless surgery with no differences as compared to control patients except in JW patients with a very low level of post-operative hemoglobin not supported by immediate transfusions.
Identifiants
pubmed: 36401716
doi: 10.1007/s11739-022-03142-2
pii: 10.1007/s11739-022-03142-2
doi:
Substances chimiques
Hemoglobins
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
151-162Informations de copyright
© 2022. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).
Références
Official Website of Jehovah’s Witnesses. https://www.jw.org/en/ . Accessed July 1, 2022. Accessed.
Rashid M, Kromah F, Cooper C (2021) Blood transfusion and alternatives in jehovah’s witness patients. Curr Opin Anaesthesiol 34(2):125–130. https://doi.org/10.1097/aco.0000000000000961
doi: 10.1097/aco.0000000000000961
Rollins KE, Contractor U, Inumerable R, Lobo DN (2016) Major abdominal surgery in jehovah’s witnesses. Ann R Coll Surg Engl 98(8):532–537. https://doi.org/10.1308/rcsann.2016.0210
doi: 10.1308/rcsann.2016.0210
Adamson JW (2008) New blood, old blood, or no blood? N Engl J Med 358(12):1295–1296. https://doi.org/10.1056/NEJMe0800520
doi: 10.1056/NEJMe0800520
Cooper L, Ford K, Miller E (2013) Preparing a jehovah’s witness for major elective surgery. BMJ 346:f1588. https://doi.org/10.1136/bmj.f1588
doi: 10.1136/bmj.f1588
Jubouri M, Hedayat F, Abrar S, Mellor SL, Brown LJ, Harky A (2022) Optimising bloodless cardiovascular surgery for jehovah’s witnesses and beyond. Coron Artery Dis 31(1):52–60. https://doi.org/10.1097/mca.0000000000001050
doi: 10.1097/mca.0000000000001050
Ranucci M, Baryshnikova E, Castelvecchio S, Pelissero G (2013) Major bleeding, transfusions, and anemia: the deadly triad of cardiac surgery. Ann Thorac Surg 96(2):478–485. https://doi.org/10.1016/j.athoracsur.2013.03.015
doi: 10.1016/j.athoracsur.2013.03.015
Dyke C, Aronson S, Dietrich W, Hofmann A, Karkouti K, Levi M et al (2014) Universal definition of perioperative bleeding in adult cardiac surgery. J Thorac Cardiovasc Surg 147(5):1458–63.e1. https://doi.org/10.1016/j.jtcvs.2013.10.070
doi: 10.1016/j.jtcvs.2013.10.070
Koch CG, Li L, Duncan AI, Mihaljevic T, Loop FD, Starr NJ et al (2006) Transfusion in coronary artery bypass grafting is associated with reduced long-term survival. Ann Thorac Surg 81(5):1650–1657. https://doi.org/10.1016/j.athoracsur.2005.12.037
doi: 10.1016/j.athoracsur.2005.12.037
Marchi G, Busti F, Girelli D (2020) Sparing unnecessary transfusions through patient blood management: time for application also in internal and emergency medicine. Intern Emerg Med 15(4):559–561. https://doi.org/10.1007/s11739-020-02278-3
doi: 10.1007/s11739-020-02278-3
Motta I, Mantovan G, Consonni D, Brambilla AM, Materia M, Porzio M et al (2020) Treatment with ferric carboxymaltose in stable patients with severe iron deficiency anemia in the emergency department. Intern Emerg Med 15(4):629–634. https://doi.org/10.1007/s11739-019-02223-z
doi: 10.1007/s11739-019-02223-z
McCartney S, Guinn N, Roberson R, Broomer B, White W, Hill S (2014) Jehovah’s witnesses and cardiac surgery: a single institution’s experience. Transfusion 54(10 Pt 2):2745–2752. https://doi.org/10.1111/trf.12696
doi: 10.1111/trf.12696
Pompei E, Tursi V, Guzzi G, Vendramin I, Ius F, Muzzi R et al (2010) Mid-term clinical outcomes in cardiac surgery of jehovah’s witnesses. J Cardiovasc Med (Hagerstown) 11(3):170–174. https://doi.org/10.2459/JCM.0b013e3283330752
doi: 10.2459/JCM.0b013e3283330752
Marinakis S, Van der Linden P, Tortora R, Massaut J, Pierrakos C, Wauthy P (2016) Outcomes from cardiac surgery in jehovah’s witness patients: experience over twenty-one years. J Cardiothorac Surg 11(1):67. https://doi.org/10.1186/s13019-016-0455-6
doi: 10.1186/s13019-016-0455-6
Wauthy P, Pierrakos C, Chebli L, Tortora R (2019) Long-term survival and quality of life in jehovah’s witnesses after cardiac surgery: a case control study. BMC Cardiovasc Disord 19(1):73. https://doi.org/10.1186/s12872-019-1061-z
doi: 10.1186/s12872-019-1061-z
Vasques F, Kinnunen EM, Pol M, Mariscalco G, Onorati F, Biancari F (2016) Outcome of jehovah’s witnesses after adult cardiac surgery: systematic review and meta-analysis of comparative studies. Transfusion 56(8):2146–2153. https://doi.org/10.1111/trf.13657
doi: 10.1111/trf.13657
Nashef SAM, Roques F, Michel P, Gauducheau E, Lemeshow S, Salamon R et al (1999) European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg 16(1):9–13. https://doi.org/10.1016/s1010-7940(99)00134-7
doi: 10.1016/s1010-7940(99)00134-7
Shanmugam G, West M, Berg G (2005) Additive and logistic EuroSCORE performance in high risk patients. Interact Cardiovasc Thorac Surg 4(4):299–303. https://doi.org/10.1510/icvts.2004.104042
doi: 10.1510/icvts.2004.104042
Wahba A, Milojevic M, Boer C, De Somer F, Gudbjartsson T, van den Goor J et al (2020) 2019 EACTS/EACTA/EBCP guidelines on cardiopulmonary bypass in adult cardiac surgery. Eur J Cardiothorac Surg 57(2):210–251. https://doi.org/10.1093/ejcts/ezz267
doi: 10.1093/ejcts/ezz267
Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J et al (2011) Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the bleeding academic research consortium. Circulation 123(23):2736–2747. https://doi.org/10.1161/circulationaha.110.009449
doi: 10.1161/circulationaha.110.009449
Lewis CT, Murphy MC, Cooley DA (1991) Risk factors for cardiac operations in adult jehovah’s witnesses. Ann Thorac Surg 51(3):448–450. https://doi.org/10.1016/0003-4975(91)90862-k
doi: 10.1016/0003-4975(91)90862-k
Pattakos G, Koch CG, Brizzio ME, Batizy LH, Sabik JF, Blackstone EH et al (2012) Outcome of patients who refuse transfusion after cardiac surgery: a natural experiment with severe blood conservation. Arch Intern Med 172(15):1154–1160. https://doi.org/10.1001/archinternmed.2012.2449
doi: 10.1001/archinternmed.2012.2449
Bhaskar B, Jack RK, Mullany D, Fraser J (2010) Comparison of outcome in jehovah’s witness patients in cardiac surgery: an Australian experience. Heart Lung Circ 19(11):655–659. https://doi.org/10.1016/j.hlc.2010.07.010
doi: 10.1016/j.hlc.2010.07.010
Stamou SC, White T, Barnett S, Boyce SW, Corso PJ, Lefrak EA (2006) Comparisons of cardiac surgery outcomes in jehovah’s versus Non-jehovah’s witnesses. Am J Cardiol 98(9):1223–1225. https://doi.org/10.1016/j.amjcard.2006.05.055
doi: 10.1016/j.amjcard.2006.05.055
Reyes G, Nuche JM, Sarraj A, Cobiella J, Orts M, Martin G et al (2007) Bloodless cardiac surgery in jehovah’s witnesses: outcomes compared with a control group. Rev Esp Cardiol 60(7):727–731
doi: 10.1157/13108278
Sander S, Singer-Englar T, Nishihara K, Esmailian F, Patel JK, Kobashigawa JA et al (2021) Heart transplant in jehovah’s witness patients: a case-control study. J Heart Lung Transplant 40(7):575–579. https://doi.org/10.1016/j.healun.2021.03.014
doi: 10.1016/j.healun.2021.03.014
Rosengart TK, Helm RE, DeBois WJ, Garcia N, Krieger KH, Isom OW (1997) Open heart operations without transfusion using a multimodality blood conservation strategy in 50 jehovah’s witness patients: implications for a “bloodless” surgical technique. J Am Coll Surg 184(6):618–629
Chambault AL, Brown LJ, Mellor S, Harky A (2021) Outcomes of cardiac surgery in jehovah’s witness patients: a review. Perfusion 36(7):661–671. https://doi.org/10.1177/0267659120980375
doi: 10.1177/0267659120980375
Vaislic CD, Dalibon N, Ponzio O, Ba M, Jugan E, Lagneau F et al (2012) Outcomes in cardiac surgery in 500 consecutive Jehovah’s witness patients: 21 year experience. J Cardiothorac Surg 7:95. https://doi.org/10.1186/1749-8090-7-95
doi: 10.1186/1749-8090-7-95
Tanaka A, Ota T, Uriel N, Asfaw Z, Onsager D, Lonchyna VA et al (2015) Cardiovascular surgery in jehovah’s witness patients: the role of preoperative optimization. J Thorac Cardiovasc Surg 150(4):976–983. https://doi.org/10.1016/j.jtcvs.2015.06.059
doi: 10.1016/j.jtcvs.2015.06.059
Mueller MM, Van Remoortel H, Meybohm P, Aranko K, Aubron C, Burger R et al (2019) Patient blood management: recommendations from the 2018 frankfurt consensus conference. JAMA 321(10):983–997. https://doi.org/10.1001/jama.2019.0554
doi: 10.1001/jama.2019.0554
Klein A, Agarwal S, Cholley B, Fassl J, Griffin M, Kaakinen T et al (2022) A review of European guidelines for patient blood management with a particular emphasis on antifibrinolytic drug administration for cardiac surgery. J Clin Anesth 78:110654. https://doi.org/10.1016/j.jclinane.2022.110654
doi: 10.1016/j.jclinane.2022.110654
Pagano D, Milojevic M, Meesters MI, Benedetto U, Bolliger D, von Heymann C et al (2017) 2017 EACTS/EACTA Guidelines on patient blood management for adult cardiac surgery. Eur J Cardiothorac Surg 53(1):79–111. https://doi.org/10.1093/ejcts/ezx325
doi: 10.1093/ejcts/ezx325
Mazer CD, Whitlock RP, Fergusson DA, Hall J, Belley-Cote E, Connolly K et al (2017) Restrictive or liberal red-cell transfusion for cardiac surgery. N Engl J Med 377(22):2133–2144. https://doi.org/10.1056/NEJMoa1711818
doi: 10.1056/NEJMoa1711818
Koch CG, Li L, Duncan AI, Mihaljevic T, Cosgrove DM, Loop FD et al (2006) Morbidity and mortality risk associated with red blood cell and blood-component transfusion in isolated coronary artery bypass grafting. Crit Care Med 34(6):1608–1616. https://doi.org/10.1097/01.CCM.0000217920.48559.D8
doi: 10.1097/01.CCM.0000217920.48559.D8
Hogervorst EK, Rosseel PM, van de Watering LM, Brand A, Bentala M, van der Bom JG et al (2016) intraoperative anemia and single red blood cell transfusion during cardiac surgery: an assessment of postoperative outcome including patients refusing blood transfusion. J Cardiothorac Vasc Anesth 30(2):363–372. https://doi.org/10.1053/j.jvca.2015.10.021
doi: 10.1053/j.jvca.2015.10.021
Carson JL, Noveck H, Berlin JA, Gould SA (2002) Mortality and morbidity in patients with very low postoperative Hb levels who decline blood transfusion. Transfusion 42(7):812–818. https://doi.org/10.1046/j.1537-2995.2002.00123.x
doi: 10.1046/j.1537-2995.2002.00123.x
Shander A, Javidroozi M, Naqvi S, Aregbeyen O, Caylan M, Demir S et al (2014) An update on mortality and morbidity in patients with very low postoperative hemoglobin levels who decline blood transfusion (CME). Transfusion 54(10 Pt 2):2688–2695. https://doi.org/10.1111/trf.12565
doi: 10.1111/trf.12565
Guinn NR, Roberson RS, White W, Cowper PA, Broomer B, Milano C et al (2015) Costs and outcomes after cardiac surgery in patients refusing transfusion compared with those who do not: a case-matched study. Transfusion 55(12):2791–2798. https://doi.org/10.1111/trf.13246
doi: 10.1111/trf.13246