Rupture of chronic type B aortic dissection in a Jehovah's Witness: successful surgical repair without blood transfusion.

Abstract:

:The patient, a 55-year-old female Jehovah's Witness who had suffered type B aortic dissection since the age of 53 years, presented with enlargement of the false lumen in the distal aortic arch and was subsequently admitted to our hospital. While hospitalized, her enlarged false lumen ruptured and she underwent replacement of the distal aortic arch and descending thoracic aorta without blood transfusion. Blood conservation strategies for this patient included the following: 1) meticulous hemostasis when incising muscle or soft tissue, 2) minimal use of gauze and discard suckers, 3) exclusive use of a cell salvage device "from skin to skin," 4) low-prime cardiopulmonary bypass, 5) minimal laboratory blood sampling, and 6) preoperative and postoperative erythropoietin treatment. Hemoglobin (Hb) values were 12.5, 15.5, 10.0, and 9.7 g/dL on admission, before rupture, after rupture, and just after the operation, respectively. The patient had an uneventful postoperative course, except for prolonged rehabilitation. The postoperative lowest Hb value was 5.2 g/dL on postoperative day 5, and the Hb value at hospital discharge (postoperative day 55) was 11.0 g/dL. Our experience with blood conservation surgery on this Jehovah's Witness patient suggests that ruptured chronic type B aortic dissection can be safely repaired on bypass through a left thoracotomy with no blood transfusion if the preoperative Hb value is >10.0 g/dL.

journal_name

Ann Vasc Surg

authors

Yamamoto H,Yamamoto F,Yamaura G,Motokawa M,Tanaka F,Sato H,Ishibashi K,Shiroto K

doi

10.1016/j.avsg.2011.08.019

subject

Has Abstract

pub_date

2012-05-01 00:00:00

pages

571.e11-6

issue

4

eissn

0890-5096

issn

1615-5947

pii

S0890-5096(11)00603-0

journal_volume

26

pub_type

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