DOI: 10.36347/sjmcr.2020.v08i02.008

Pages: 126-127

Background: Jehovah’s Witnesses are a subgroup of Christianity who refrained from blood transfusions. As of 2017, there were reported 5069 Jehovah’s Witnesses in Malaysia. However, this is concerning as cardiac surgery is known to be associated with a high risk of perioperative blood loss and allogeneic blood transfusions. Recent studies always compared restrictive (Hb 7.0–8.0 g/dl) and liberal (Hb 9.0–10.0 g/dl) transfusion strategies. No study took into consideration the outcomes of patients with Hb less than 7.0g/dl. We are reporting a case and outcome of a patient who required a Redo Triple Valve surgery with no blood transfusion. Methods: 40 year old Jehovah’s female, with underlying CRHD who underwent a DVR (Aortic & Mitral) (Tissue) in 2004 currently presented with degenerative prosthetic valve. Upon sternotomy dense adhesions were noted. Meticulous resections and hemostasis was achieved as surgery progressed with the adjunct of Cell saver. Bicaval canulation and selective cardioplegia administration via coronary ostium was performed. Mitral valve was accessed via a transeptal approach and replaced with a size 27/29 mm On-X valve. As the STJ was only 19mm, root enlargement with autologous pericardium was performed and a size 19mm SJM valve was implanted. Cross clamp was released and Devega TAP was performed on a beating heart. Patient came off bypass with minimal support. Bypass time was 276minutes with Cross clamp time of 235 minutes and blood loss of 300mls.Chest was packed overnight and left opened to conserve blood and optimize clotting. Delayed chest closure was performed on POD 1 and patient was extubated POD 3.POD 4 patients documented Hb was 5.0g/dl, however patient compensated well and did not require any blood transfusion or inotropic support. Patient was discharged well on POD 9 with a Hemoglobin level of 6.7g/dl. Discussion: Preoperatively, patient was given IV iron and Hb level was boosted. During surgery the use of Cell Saver and meticulous....