Outcome after cardiac surgery in Jehovah’s Witnesses

OBJECTIVES: Jehovah's Witnesses categorically refuse allogenic blood transfusions on religious grounds, a major challenge if intervention for heart disease is required. We retrospectively analyzed outcome after open-heart surgery in 26 Jehovah's Witnesses. METHODS: Jehovah's Witnesses undergoing open heart surgery between 2010 and June 2025 were compared to matched patients operated at our clinic by year of surgery, age, gender and type of surgical procedure. RESULTS: Seven of the Jehovah's Witnesses (27%) were not accepted for open-heart surgery at other clinics because of an assumed high risk, three of whom were admitted from abroad. Two patients were operated on for acute aortic dissection. Six of the Jehovah's Witnesses (23%) had previously undergone open-heart surgery, two of whom required reoperation for prosthetic valve endocarditis. There was one early death (4%) among the Jehovah's Witnesses from renal failure and septicaemia at haemoglobin 44 g/L. Cardiopulmonary bypass, aortic occlusion and total time of the operation, bleeding and hospital stay and postoperative complications did not differ significantly in Jehovah's Witnesses and matched patients. Eleven of the 26 matched patients (42%) received blood transfusion. Mean haemoglobin before the operation, lowest recorded level, and level at discharge from hospital and at follow-up one to three months after the operation did not differ significantly in the two groups. Haemoglobin level after the operation recovered within three months. CONCLUSIONS: Complex cardiac surgery can be performed with low risk in Jehovah's Witnesses. Blood conservation should be applied at all operations to avoid unnecessary blood transfusion.