Background: Patients refusing blood product transfusion represent a particular cardiac surgery population in which bleedings and hemodilution should be maximally reduced.
Case presentation: We present the case of a 60 years old, Jehovah witness patient refusing whole blood transfusion and primary blood components, who required surgery for severe and symptomatic mitral valve regurgitation. To avoid critical bleeding, we performed careful preoperative assessment, documenting coagulation anamnesis and accepted drugs using a standardized form. In case of a bleeding, the anesthesia team was prepared for a proactive and goal-oriented correction of the coagulation using artificial products. Should it be needed, measures to increase anemia tolerance would also have taken place, for example narcosis deepening. The operation was performed in a minimally invasive fashion using a right anterior thoracotomy and video-assistance. The cardiopulmonary bypass was conducted using 3/8 inches venous lines and small-sized oxygenator in order to reduce priming volume. Using a ring anuloplasty and plication of the anterior mitral valve leaflet, mitral valve repair was achieved with no sign of regurgitation or stenosis. The postoperative course was uneventful and the patient was discharged on postoperative day 8 with a hemoglobin level of 109g/l.
Conclusion: Patient refusing blood transfusion represent a particular subset of the cardiac surgery population. In order to offer standard of care in such situations, a multidisciplinary, patient-centered concept based on close collaboration between cardiac surgeons, anesthetists and perfusionist is of utmost importance. In this case we, once again, demonstrated the safety and feasibility of minimally invasive mitral valve repair and its usefulness in patients where reduced hemodilution and fast recovery are needed.