Transfusion-Free Surgery for a Jehovahfs Witness Patient with Dilated Cardiomyopathy Treated with Mitral Complex Reconstruction

(Department of Cardiovascular Surgery, NTT East Sapporo Hospital, Sapporo, Japan, Division of Medical Sciences, Health Sciences University of Hokkaido*, Hokkaido, Japan and Department of Cardiovascular Surgery, Hokkaido University Hospital**, Sapporo, Japan)

Masatoshi Motohashi Akira Adachi Ko Takigami
Keishu Yasuda Shigeyuki Sasaki* Yoshiro Matsui**
A 22-year-old man with dilated cardiomyopathy (DCM), who was a practicing Jehovahfs Witness, was transferred to our hospital for surgical treatment of medically uncontrollable mitral regurgitation (MR). Our original mitral complex reconstruction procedure and permanent pacemaker implantation for biventricular pacing were successfully performed without transfusion of blood products. Blood conservation strategy included: 1) preoperative treatment with erythropoietin, 2) utilization of a shortened extracorporeal circuit and assisted venous drainage system, 3) the use of ultrafiltration to save the residual autoblood in the extracorporeal circuit. The preoperative hemoglobin level was 17.1g/dl and the postoperative lowest level was 9.5g/dl. MR decreased from grade III to none, and NYHA functional class improved from class II to class I postoperatively. He was moved to a cardiology ward on the 13th postoperative day without complications. Transfusion-free surgery for DCM should be performed before DCM advances and requires left ventriculoplasty at risk for major blood loss. A careful follow-up is needed to examine the long-term results of the operative procedure during his expected long survival.
@Jpn. J. Cardiovasc. Surg. 36: 361-365 (2007)