RISK-FACTORS FOR CARDIAC OPERATIONS IN ADULT JEHOVAHS-WITNESSES

During a 27-year-period, 663 adults of the Jehovah's Witness faith underwent open heart procedures at the Texas Heart Institute. To determine the effect of recent changes in operative techniques and in the patient population itself on early mortality, we reevaluated the surgical outcome in this special group of patients. We reviewed the charts of 88 consecutive Jehovah's Witness patients who had an open heart operation between January 1986 and March 1989 and compared demographic variables in this group with those of 575 patients who underwent operation between May 1963 and January 1986. In our recent series, patients were older (mean age, 61 years versus 54 years), and 16% were seen for repeat procedures. Early mortality (less-than-or-equal-to 30 days postoperatively) was lower in the recent series than in the earlier series (7.0% versus 10.7%), but the difference between the groups was not statistically significant. We identified several important factors associated with an increased risk of early death in the recent group of patients. These factors included repeat cardiac operations (p < 0.01), especially for valvar dysfunction, severe left ventricular dysfunction (defined as an ejection fraction < 0.35) (p < 0.01), and a hemoglobin level lower than 80 g/L (8 g/dL) (p < 0.01) on postoperative day 1. Although blood loss remains the leading cause of death in these patients, cardiac operations can be performed with an acceptable mortality.