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Vitolo M, Mei DA, Cimato P, Bonini N, Imberti JF, Cataldo P, Menozzi M, Filippini T, Vinceti M, Boriani G. Cardiac Surgery in Jehovah's Witnesses Patients and Association With Peri-Operative Outcomes: A Systematic Review and Meta-Analysis. Curr Probl Cardiol 2023; 48:101789. [PMID: 37172869 DOI: 10.1016/j.cpcardiol.2023.101789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 05/07/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Strategies for blood conservation, coupled with a careful preoperative assessment, may be applied to Jehovah's Witnesses (JW) patients who are candidates for cardiac surgery interventions. There is a need to assess clinical outcomes and safety of bloodless surgery in JW patients undergoing cardiac surgery. METHODS We performed a systematic review and meta-analysis of studies comparing JW patients with controls undergoing cardiac surgery. The primary endpoint was short-term mortality (in-hospital or 30-day mortality). Peri-procedural myocardial infarction, re-exploration for bleeding, pre-and postoperative Hb levels and cardiopulmonary bypass (CPB) time were also analyzed. RESULTS A total of 10 studies including 2,302 patients were included. The pooled analysis showed no substantial differences in terms of short-term mortality among the two groups (OR 1.13, 95% CI 0.74-1.73, I2=0%). There were no differences in peri-operative outcomes among JW patients and controls (OR 0.97, 95% CI 0.39-2.41, I2=18% for myocardial infarction; OR 0.80, 95% CI 0.51-1.25, I2=0% for re-exploration for bleeding). JW patients had a higher level of preoperative Hb (Standardized Mean Difference [SMD] 0.32, 95% CI 0.06-0.57) and a trend toward a higher level of postoperative Hb (SMD 0.44, 95% CI -0.01-0.90). A slightly lower CPB time emerged in JWs compared with controls (SMD -0.11, 95% CI -0.30-0.07). CONCLUSIONS JW patients undergoing cardiac surgery, with avoidance of blood transfusions, did not have substantially different peri-operative outcomes compared with controls, with specific reference to mortality, myocardial infarction, and re-exploration for bleeding. Our results support the safety and feasibility of bloodless cardiac surgery, applying patient blood management strategies.
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Affiliation(s)
- Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Davide A Mei
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Paolo Cimato
- Department of Cardiac Surgery, Villa Torri Hospital, GVM Care & Research, Bologna, Italy
| | - Niccolò Bonini
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Jacopo F Imberti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Paolo Cataldo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Matteo Menozzi
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Tommaso Filippini
- Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia Modena Italy; School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | - Marco Vinceti
- Environmental, Genetic and Nutritional Epidemiology Research Center, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia Modena Italy; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.
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Amorim Filho FS, Gripp FM, Faria GS, Capuzzo Gonçalves M, Miyahira L. Hemangiopericytoma: Conducts and perioperative management of an extent sinonasal tumor in a Jehovah's Witnesses patient - Case report. Cancer Rep (Hoboken) 2022; 5:e1609. [PMID: 35194976 PMCID: PMC9458489 DOI: 10.1002/cnr2.1609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 01/02/2022] [Accepted: 01/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background Hemangiopericytomas (HPCs) are rare tumors derived from mesenchymal cells with pericyte differentiation. About 5% of head and neck HPCs occur in the nasal cavity and paranasal sinuses. Due to its rarity, rich vascularity and variable biological behavior, its management is a challenge in itself. Case We report a case of sinonasal HPC in a Jehovah's Witness patient and discuss the obstacles and care related to the restrictions and therapeutic challenges involved in the approach to the patient. The patient was successfully treated by endoscopic endonasal approach with all per‐operative care and restrictions being respected and attended. Conclusions The management of HPC by itself involves challenges and when associated with other restrictive conditions attention and care are required.
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Affiliation(s)
- Francisco S Amorim Filho
- Head and Neck Surgery and Otorhinolaryngology Service, Instituto da Tireoide e Laringe, Goiânia, Brazil.,Department of Otorhinolaryngology and Head and Neck Surgery, Hospital das Clínicas de Goiânia (HC-UFG), Goiânia, Brazil
| | - Flávio M Gripp
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Campinas (UNICAMP), Campinas, Brazil
| | - Guilherme S Faria
- Head and Neck Surgery and Otorhinolaryngology Service, Instituto da Tireoide e Laringe, Goiânia, Brazil
| | - Mateus Capuzzo Gonçalves
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital das Clínicas de Goiânia (HC-UFG), Goiânia, Brazil
| | - Lincoln Miyahira
- Head and Neck Surgery and Otorhinolaryngology Service, Instituto da Tireoide e Laringe, Goiânia, Brazil
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Kholaki O, Wentland TR, Kim RY. Substernal goiter excision in a Jehovah's Witness. Proc (Bayl Univ Med Cent) 2020; 33:462-464. [PMID: 32675989 DOI: 10.1080/08998280.2020.1739483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 02/24/2020] [Accepted: 02/27/2020] [Indexed: 10/24/2022] Open
Abstract
Jehovah's Witnesses present a unique challenge in oral and head and neck surgery. We report a case of a substernal goiter excised on a Jehovah's Witness without the use of blood transfusion, in accordance with the patient's beliefs. Additionally, we review the literature on the care of this patient population, focusing on preoperative optimization, perioperative management, and postoperative care.
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Affiliation(s)
- Omar Kholaki
- Division of Oral and Maxillofacial Surgery, Department of Surgery, Parkland/University of Texas Southwestern Medical CenterDallasTexas
| | - Todd R Wentland
- Division of Maxillofacial Oncology and Reconstructive Surgery, Department of Oral and Maxillofacial Surgery, John Peter Smith Health NetworkFort WorthTexas
| | - Roderick Y Kim
- Division of Maxillofacial Oncology and Reconstructive Surgery, Department of Oral and Maxillofacial Surgery, John Peter Smith Health NetworkFort WorthTexas
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Redmann AJ, Schopper M, Ragsdale J, Rutter MJ, Hart CK, Myer CM. Posttonsillectomy Hemorrhage in a Pediatric Jehovah's Witness and the Decision to Transfuse. Otolaryngol Head Neck Surg 2018; 159:238-241. [PMID: 29807476 DOI: 10.1177/0194599818772044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Andrew J Redmann
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Melissa Schopper
- 2 University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Judith Ragsdale
- 3 Department of Pastoral Care, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Michael J Rutter
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA.,4 Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Catherine K Hart
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA.,4 Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Charles M Myer
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA.,4 Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Oh SY, Kim SH, Kwon HC, Lee S, Kim KH, Kwon KA, Lee JH, Lee KY, Kim HJ. Bloodless cancer treatment results of patients who do not want blood transfusion: single center experience of 77 cases. Support Care Cancer 2009; 18:1341-6. [DOI: 10.1007/s00520-009-0759-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Accepted: 10/01/2009] [Indexed: 10/20/2022]
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Dionigi G, Boni L, Rovera F, Rausei S, Cuffari S, Cantone G, Bacuzzi A, Dionigi R. Effect of perioperative blood transfusion on clinical outcomes in hepatic surgery for cancer. World J Gastroenterol 2009; 15:3976-83. [PMID: 19705491 PMCID: PMC2731946 DOI: 10.3748/wjg.15.3976] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Allogeneic blood transfusion during liver resection for malignancies has been associated with an increased incidence of different types of complications: infectious complications, tumor recurrence, decreased survival. Even if there is clear evidence of transfusion-induced immunosuppression, it is difficult to demonstrate that transfusion is the only determinant factor that decisively affects the outcome. In any case there are several motivations to reduce the practice of blood transfusion. The advantages and drawbacks of different transfusion alternatives are reviewed here, emphasizing that surgeons and anesthetists who practice in centers with a high volume of liver resections, should be familiar with all the possible alternatives.
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