The Hindu : Tamil Nadu / Chennai News : A bypass without blood transfusion

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Thursday, Jan 08, 2009
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Tamil Nadu

Tamil Nadu - Chennai

A bypass without blood transfusion

Special Correspondent

CHENNAI: A Coronary Artery Bypass Surgery without blood transfusion? Strange, but true. Doctors at a city hospital performed a CABG and valve replacement surgery on a 75-year-old male, stopping short of giving him a blood transfusion in deference to his religious wishes.

The patient, Thirumalachary, is part of an Adventist sect that is principally opposed to blood transfusion – Jehovah’s Witnesses. Members of the sect refuse to undergo blood transfusions even in complex surgeries, believing that it would be a sin. He was also opposed to auto transfusion, using the patient’s own blood collected and stored pre-surgery, or during and after the surgery. Normally, this would put most cardiac surgeons off the case. But when Mr. Thirumalachary approached S. Thiagarajamurthy, chief cardio-thoracic surgeon, who has had some experience working with the sect during his tenure in England, however decided to give it a go.

With the backing of the team, including cardiologists K. Dhamodaran and U. Ilayaraja, cardiac anaesthetists R. Mahadevan and K. Nedumaran, he performed the surgery without transfusion of blood, and with minimal loss of blood. The patient was discharged at the end of December and apparently walked to a press meet at the hospital on Wednesday.

Preparations for the complex surgery began three weeks before surgery, when the patient was given erythropoietin to induce red blood cell generation by the body. In a conventional CABG and AVR, the heart needs to be stopped over a period of time and the average blood usage is four to six units per surgery, Dr. Thiagarajamurthy explained.

Since Mr. Thirumalachary was opposed to blood transfusion, the strategy was to conserve blood as much as possible, by using the Acute Normovolaemic haemodilution process. Here, the patient’s blood is diverted to a blood bag and continues to run through his arteries and veins, without the link between the patient and his blood being severed as in the conventional process, where it is drawn and collected in a bag.

The CABG was done on a beating heart and this was followed by a short exposure to a heart-lung machine after the heart was stopped to facilitate valve replacement. The patient was also given transemic acid to control severe bleeding.

“His total blood loss, including the pre-operative phase was only 200 ml. He was discharged a week after surgery and is now free from the breathlessness and chest pain that has been bothering him for a year now,” Dr. Thiagarajamurthy said.

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