Jehovah's witnesses who require open heart surgery present a great challenge to the surgeon because of their refusal to accept any blood transfusion for religious reasons.
Five (5) open heart surgeries were performed in these patients at the Philippine Heart Center for Asia from September, 1981 to September, 1982, two (2) of whom underwent primary ASD clocure, two (2) with valve replacement and one (1) with VSD patch closure pulmonary valvulotomy and infundibulectomy. Patients' age range from 20-40 years with a mean age of 26 years and an average weight of 40 kg.
The pump oxygenator was primed with Normosol R ph 7.4, D5 0.3 percent NACI, 20 percent Mannitol and sodium bicarbonate (NaHCO3). Bypass was performed under mild to moderate hypothermia (28-34xC), flow rates range from 2.2-2.6 1/m\}/min. No blood nor blood derivatives were given perioperatively.
Post-operatively, there was no mortality and satisfactory recovery was achieved. Blood components were notably decreased (hemoglobin level of 6 mg. percent), the level being proportional to the length of bypass time. In this series, most of the operations were done in less than an hour cardio-pulmonary (C-P) bypass time. This shortened bypass time together with good hemostasis and total correction of cardiac lesion are the main factors toward successful results in these patients. Our local experience supports that open heart surgery without blood transfusion in Jehovah's witness patients can be done with an acceptably low risk.