RESULTS OF OPEN-HEART-SURGERY IN ADULT ME MBERS OF JEHOVAH-WITNESSES

Members of Jehovah's Witnesses refuse blood transfusions and blood pro ducts under any circumstances. Because of an improvement in blood salv age techniques in our centre, they are not excluded from open heart su rgery. In recent years recombinant human erythropoietin (rhEPO) has be en applied to correct perioperative anemia in these patients. Methods. Seventeen members of Jehovah's Witnesses who were more than 18 years of age were operated on using various blood salvage technique, e.g., h aemoseparation and a high dose of Aportinin. We present the first thre e patients treated with 4x500 U of i.v. rhEPO/kg body wt. given within II days preoperatively. Thirteen of the patients operated on had elev ated preoperative risk factors, for instance poor left ventricle, seve re aortic valve stenosis, metabolic syndrome, age older than 70 years, etc. In other centres that perform cardiac operations on members of J ehovah's Witnesses, these risk factors represent contraindications for open-heart surgery in these patients. Results. Patients with rhEPO tr eatment showed a preoperative hematocrit increase of 7 Vol.% within 10 days and no postoperative complications. At the 6th postoperative hou r the hematocrit returned to the starting values; in patients without rhEPO, however, the hematocrit generally had not increased to preopera tive values even by the 8th day after operation. In 9 patients with pr eoperative elevated risk factors and a postoperative relative decrease in hematocrit below 33% we observed an uncomplicated postoperative pe riod. Four patients with these risk factors, a pronounced decrease in hematocrit and blood loss postoperatively had various severe complicat ions. Conclusions. Preoperative treatment with a high dose of rhEPO to enhance the hematocrit and maturity by precursor red blood cells in p atients with a hematocrit below 45 Vol.% is a possibility to compensat e for the blood loss perioperatively and to avoid complications from a decrease in oxygen transport capacity. The anaemia and high blood los s postoperatively are the main causes for a slightly elevated operatio n risk in members of Jehovah's Witnesses in all heart centres that per form cardiac operations on these patients. Nevertheless, Jehovah's Wit nesses should be not excluded from cardiac operations, since open-hear t surgery without use of homologous blood is becoming a routine proced ure.