Abstract
BACKGROUND: Jehovah's Witness patients present unique challenges in cardiac surgery given their refusal of blood transfusion. This complexity is amplified in reoperative and congenital cases. CASE SUMMARY: A 60-year-old, 45-kg Jehovah's Witness woman with complex congenital heart disease and prior cardiac interventions underwent successful third-time sternotomy for mechanical aortic valve replacement, ascending aortic replacement, patent ductus arteriosus ligation, and double-chamber right ventricle repair using a bloodless strategy. A multidisciplinary approach was used to optimize her physiology preoperatively. Intraoperative management included cell salvage, autologous transfusion, and hemostatic agents. She was discharged on day 24 with preserved cardiac function. DISCUSSION: This case highlights the feasibility of high-risk, bloodless congenital reoperations through careful perioperative planning, preoperative imaging, and adherence to institutional blood conservation protocols. TAKE-HOME MESSAGES: Multidisciplinary planning and preoperative imaging are important for procedural preparation in high-risk bloodless cardiac surgery. Institutional protocols and experience are keys to success in complex bloodless reoperations.