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Off-pump myocardial revascularizaton in a Jehovah's Witness patient with pheochromocytoma

^a Division of Cardiothoracic Surgery, Wayne State University, 3990 John R, Suite 2102, Harper, Professional Building, Detroit, MI 48201, USA
^b Chief Administrative Surgery Resident, Wayne State University, MI, USA

*Corresponding author. Tel.: +(1313) 933-0580; fax: +(1313) 033-0572.

E-mail address: Fbaciewi{at}DMC.org (F.A. Baciewicz).

We present a female Jehovah's Witness patient with concomitant severe left main and left anterior descending coronary artery disease and pheochromocytoma who underwent successful off-pump myocardial revascularization. Perioperative management of this patient included alpha-blockade with Doxazosin followed by beta-blockade with Metoprolol. A short-acting Phentolamine was used for alpha-blockade before surgery. Because she refused transfusion of blood and blood products, erythropoietin and iron was used to increase her hemoglobin in both the preoperative and postoperative periods. Intraoperative stategy included off-pump myocardial revascularization, the use of a pulmonary catheter to monitor hemodynamics, the use of norepinephrine and epinephrine to increase blood pressure, the employment of the cell saver, and transesophageal echocardiography.

Key Words: Off-pump CABG; Pheochromocytoma; Jehovah's Witness