Reoperative Cardiac Surgery in Jehovah's Witness Patients with Patent Internal Thoracic Artery Grafts: How Far Can We Push the Envelope?
DOI:
https://doi.org/10.1532/HSF98.20071144Abstract
Reoperative cardiac surgery in Jehovah's Witness (JW) patients with patent internal mammary arteries is a formidable surgical challenge. We have successfully performed 2 such cases using creative approaches. The first patient, a morbidly obese woman, presented with an acute coronary syndrome 4 years after off-pump coronary artery bypass grafting (CABG) with a hemoglobin of 10 gm/dL. She was stabilized with stenting of the culprit vessel; erythropoietin therapy was performed to increase her hemoglobin, and surgery was performed electively. The internal thoracic artery (ITA) was dissected and clamped, and intermittent cardioplegia was used for myocardial protection. The second patient needed aortic valve replacement 3 years after a previous CABG using an ITA. Limited dissection was used at redo operation without exposing the ITA. Aortic valve replacement was performed under cold fibrillatory arrest with an open ITA. Successful reoperative cardiac surgery in JW patients requires preoperative preparation using a multidisciplinary team approach and flexible operative planning.References
Dougherty JE, Gallagher RC, Hirst JA, et al. 1997. Coronary stent placement as a bridge to coronary artery bypass surgery in an unstable, anemic Jehovah's Witness patient: a case report and review of bloodless surgery techniques. Conn Med 61:195-9.nFerraris VA, Ferraris SE, Saha SP, et al. 2007. Perioperative blood transfusion and blood conservation in cardiac surgery: the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists practice guideline. Ann Thorac Surg 83(5 Suppl):S27-86.nGazmuri RJ, Ayoub IM, Kolarova JD, Karmazyn M. 2002. Myocardial protection during ventricular fibrillation by inhibition of the sodium-hydrogen exchanger isoform-1. Crit Care Med 30(4 Suppl):S166-71.nGillinov AM, Casselman FP, Lytle BW, et al. 1999. Injury to a patent left internal thoracic artery graft at coronary reoperation. Ann Thorac Surg 67:382-6.nImanaka K, Kyo S, Ogiwara M, et al. 2002. Mitral valve surgery under perfused ventricular fibrillation with moderate hypothermia. Circ J 66:450-2.nJovanovic S, Hansbro SD, Munsch CM, Cross MH. 2000. Redo cardiac surgery in a Jehovah's Witness, the importance of a multidisciplinary approach to blood conservation. Perfusion 15:251-5.nOtt DA, Cooley DA. 1977. Cardiovascular surgery in Jehovah's Witnesses: report of 542 operations without blood transfusion. JAMA 238:1256-8.nTeoh LK, Grant R, Hulf JA, Pugsley WB, Yellow DM. 2002. A comparison between ischemic preconditioning, intermittent cross-clamp fibrillation and cold crystalloid cardioplegia for myocardial protection during coronary artery bypass graft surgery. Cardiovasc Surg 10:251-5.n
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