Sarasota Cardiac & Thoracic Surgery

The Bloodless Cardiovascular
Surgery Center of Sarasota PDF - Click Here to Print

Dr. Beggs respects a patient's decision to pursue surgery without the use of blood or blood products. He has successfully completed complex lung procedures, coronary artery bypass, valve and aneurysm surgeries using bloodless surgical techniques.

Our surgeon trained with Denton Cooley, MD. Dr. Cooley performed the first bloodless open heart surgery in 1962 on a Jehovah's Witness patient. An article describing this surgery was published in 1964. Dr. Cooley was a pioneer in performing intricate heart and vascular surgery without blood on adults and children. He concludes that "the risk of surgery in patients of the Jehovah's Witness group has not been substantially higher than for others."(6) Dr. Cooley has performed 1,106 of these surgical procedures and writes that good attitude is another factor with Jehovah's Witnesses. Jehovah's Witnesses do not have the fear of complications or even death that some patients have. The Witnesses have a deep and abiding faith in their belief and in their God.(7)

There are a number of reasons why a person may prefer to receive medical and surgical care without the use of blood or blood products. Religious conviction, concern regarding possible transfusion reactions, or the risk of exposure to blood-borne illnesses are just a few reasons why our patients have traveled from across the state to have their surgery performed here.

Bloodless medicine and surgery is an advanced way of providing medical care without using or limiting the use of donor blood. Our approach maximizes a patient's blood stores prior to surgery and minimizes a patient's blood loss during and after surgery by using state-of-the-art equipment, advanced techniques, and drug therapies.

Clinical data has shown the advantages include: a faster recovery with a shorter hospital stay, reduced blood loss, reduced risk of infection or other complication, and fewer healthcare costs.

Blood Conservation Techniques

The preoperative diet consists of iron-rich foods, along with iron and vitamin supplements. It should be initiated as soon as surgery is contemplated. Absorption of iron from food is influenced by multiple factors. One important factor is the form of the iron, which you eat. Heme iron, found in animal sources, is highly available for absorption. Non-heme iron, on the other hand, found in vegetable sources, is less available. You can increase the absorption of non-heme iron by combining it with heme iron, for example, clams or mussels with enriched pasta.

For more information on the PRE-OPERATIVE DIET:
PDF - Click here to read and print

Medications

In addition to building iron stores your body may need medications to help increase red or white blood cells or hemoglobin levels. Medications may also assist with minimizing blood loss and maximizing the amount of oxygen in your blood.

Some medications that may be administered are:

• Oxygen carriers including perfluorocarbons and hemoglobin substitutes
• Aprotinin
• Aminocaproic acid
• Desmopressin
• Vasopressin
• Vitamin K
• Erythropoietin

Erythropoietin (Epogen, Procrit, epoetin) contains a small amount of human albumin (0.01%); this is acceptable to most Jehovah's Witnesses. Albumin will likely be refused conscientiously when used as a volume expander, but the amount contained in Epogen is small and therefore generally acceptable.

In addition, your physician may request that you stop taking other medications, such as aspirin or anti-inflammatory drugs. Some medications may hinder blood counts or clotting abilities. If you are a smoker, you will be strongly urged to stop smoking because it can interfere with oxygen delivery throughout your body.

Anesthesia Techniques

Your medical team may use certain anesthesia techniques during surgery including:

• Volume expanders (crystalloids/colloids) - intravenous fluid
• Carefully maintained body temperature
• Low blood pressure- blood loss is slower when the blood pressure is low.
• Normovolemic hemodilution- some of your blood is deliberately withdrawn or re-directed, and you receive an equal quantity of intravenous fluids. Thus, your blood is diluted ("hemodilution") but the normal volume is maintained ("normovolemia"). The result is that when you bleed during surgery, your diluted blood contains a lower concentration of red blood cells. At the end of the surgery, the more concentrated blood that was originally withdrawn is returned. When normovolemic hemodilution is performed using a "closed system" (the withdrawn blood continues to circulate and is not actually stored), some Jehovah's Witnesses find this therapy acceptable.
• Monitoring your blood oxygen levels.

Surgical methods

• Minimally invasive procedures are selected when possible, as the least invasive procedure can result in the lowest risk of complications and blood loss.
• The practice of "meticulous hemostasis" refers to a surgical team's scrupulous attention to even the most minute areas of bleeding during the course of surgery.
• High-tech scalpels that combine the ability to cut tissue and seal bleeding vessels at the same time, such as the harmonic scalpel (which uses ultrasound waves) and the microwave-coagulating scalpel.
• Patient position
• Cell savers- the intraoperative cell salvage machine recovers blood lost from the operative area, spins it, washes it, filters it, and returns the patient's own red blood cells back to his or her body.
• Post-operative blood salvage- through a system that is at all times connected to and in contact with a person's circulation, blood is returned through an intravenous line. This enables a patient to receive back his own non-stored blood, thus avoiding the need for blood transfusions for many patients.
• Carefully choosing the tests to be performed and using significantly smaller tubes for blood draws minimize the amount of blood used for laboratory testing.