Coronary artery bypass grafting in Jehovah’s Witness: a retrospective propensity matched cohort
study

Henrique Ryu Yamanaka Nakano; Guilherme Mota Filho; Bruno Camargo Calabria Araújo; Heloísa Zogheib; Enzo Camargo Calabria Araújo; Leonardo Cardoso Saraiva; Jessica Silva Nicolau; Suely Pereira Zeferino; José Otávio Costa Auler Junior

doi:10.1016/j.bjane.2026.844765

Original Investigation

Coronary artery bypass grafting in Jehovah’s Witness: a retrospective propensity matched cohort study

Cirurgia de revascularização do miocárdio em pacientes Testemunhas de Jeová: um estudo de coorte retrospectivo pareado por escore de propensão

Henrique Ryu Yamanaka Nakano, Guilherme Mota Filho, Bruno Camargo Calabria Araújo, Heloísa Zogheib, Enzo Camargo Calabria Araújo, Leonardo Cardoso Saraiva, Jessica Silva Nicolau, Suely Pereira Zeferino, José Otávio Costa Auler Junior

http://dx.doi.org/10.1016/j.bjane.2026.844765 Braz J Anesthesiol, vol.76, n4, 844765, 2026

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Abstract

Background

Coronary Artery Bypass Grafting (CABG) in Jehovah’s Witness (JW) patients raises concerns regarding perioperative safety because of refusal of allogeneic blood transfusions. This study evaluated the feasibility and short-term outcomes of CABG in JW patients and described perioperative blood management practices.

Methods

This retrospective observational study included 26 JW patients and 78 matched non-Jehovah’s Witness (non-JW) patients who underwent CABG at InCor HC-FMUSP between 2015 and 2023. Propensity score matching at a 3:1 ratio based on age, sex, and preoperative hemoglobin was used to improve comparability. The primary outcome was 30-day all-cause mortality. Secondary outcomes included 30-day stroke, myocardial infarction, and acute kidney injury; ICU length of stay; perioperative red blood cell transfusion rates; postoperative hemoglobin and hematocrit; intraoperative blood loss; and cardiopulmonary bypass time.

Results

No 30-day deaths occurred among JW patients, whereas three deaths occurred in the non-JW group (OR = 0.45; 95% CI 0.003–5.09; p = 0.575). No JW patient experienced stroke, and one myocardial infarction occurred. JW patients had higher postoperative hemoglobin (OR = 1.50; 95% CI 1.03–2.28; p = 0.032) and lower intraoperative blood loss (OR = 0.55; 95% CI 0.27–0.98; p = 0.046). No JW patient received transfusion, whereas 17.9% and 12.8% of non-JW patients required intraoperative and postoperative transfusions, respectively. ICU length of stay was similar between groups.

Conclusion

In this cohort, CABG in JW patients was feasible with acceptable short-term outcomes. Outcomes were generally comparable between groups, acknowledging imprecision related to the small JW sample.

Keywords

Blood component transfusion; Coronary artery bypass; Jehovah’s Witnesses; Perioperative care; Transfusion-free surgery

Resumo

Introdução

A cirurgia de revascularização do miocárdio (CRM) em pacientes Testemunhas de Jeová (TJ) levanta preocupações em relação à segurança perioperatória devido à recusa de transfusões de sangue alogênico. Este estudo avaliou a viabilidade e os desfechos de curto prazo da CRM em pacientes TJ e descreveu as práticas de manejo sanguíneo perioperatório.

Métodos

Este estudo observacional retrospectivo incluiu 26 pacientes TJ e 78 pacientes não Testemunhas de Jeová (não TJ) pareados que foram submetidos à CRM no InCor HC-FMUSP entre 2015 e 2023. O pareamento por escore de propensão na proporção de 3:1, baseado em idade, sexo e hemoglobina pré-operatória, foi utilizado para melhorar a comparabilidade. O desfecho primário foi a mortalidade por todas as causas em 30 dias. Os desfechos secundários incluíram acidente vascular cerebral (AVC), infarto do miocárdio e lesão renal aguda em 30 dias; tempo de permanência na Unidade de Terapia Intensiva (UTI); taxas de transfusão de hemácias perioperatórias; hemoglobina e hematócrito pós-operatórios; perda sanguínea intraoperatória; e tempo de circulação extracorpórea.

Resultados

Não ocorreram óbitos em 30 dias entre os pacientes TJ, enquanto três óbitos ocorreram no grupo não TJ (OR = 0,45; IC 95% 0,003–5,09; p = 0,575). Nenhum paciente TJ apresentou AVC e ocorreu um infarto do miocárdio. Os pacientes TJ apresentaram maior hemoglobina pós-operatória (OR = 1,50; IC 95% 1,03–2,28; p = 0,032) e menor perda sanguínea intraoperatória (OR = 0,55; IC 95% 0,27–0,98; p = 0,046). Nenhum paciente TJ recebeu transfusão, enquanto 17,9% e 12,8% dos pacientes não TJ necessitaram de transfusões intraoperatórias e pós-operatórias, respectivamente. O tempo de permanência na UTI foi semelhante entre os grupos.

Conclusão

Nesta coorte, a CRM em pacientes TJ foi viável, com desfechos de curto prazo aceitáveis. Os desfechos foram geralmente comparáveis entre os grupos, reconhecendo-se a imprecisão relacionada à pequena amostra de pacientes TJ.

Palavras-chave

Transfusão de componentes sanguíneos; Revascularização do miocárdio; Testemunhas de Jeová; Assistência perioperatória; Cirurgia sem transfusão

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Submitted date:
09/28/2025

Accepted date:
05/03/2026