Chester County Hospital Unveils Transfusionless Heart Surgery

Technique Pioneered at Pennsylvania Hospital Makes its Suburban Debut

Last spring, Chester County Hospital (CCH) began offering transfusionless heart surgery to help meet growing demand in the Greater Philadelphia region.

There are few cardiac surgery programs in the suburbs that feature these innovative surgical techniques that help patients get the care they need without the use of blood or blood products. This offering can benefit many patients, but is vital for culturally appropriate care for patients with certain religious beliefs, particularly Jehovah’s Witnesses. Jehovah’s Witnesses adhere to a literal interpretation of a Bible scripture, Acts 15:29, that says, “to keep abstaining from things sacrificed to idols, from blood, from what is strangled….” This is a large population with unique health care needs in the Philadelphia region, including the Chester County suburbs.

“Our position is that we refuse whole blood and its four major components: red cells, white cells, plasma, and platelets,” says Terry Robinson, a minister with the Hospital Liaison Committee for Jehovah’s Witnesses in Philadelphia. He has been advising Satoshi Furukawa, MD, chief of Cardiovascular Surgery at Pennsylvania Hospital (PAH) and the surgeon who will be performing all the transfusionless heart surgeries at Chester County Hospital.

A transfusionless surgery does not necessitate a blood transfusion or a blood product, according to Patricia A. Ford, MD, director for the Center for Bloodless Medicine and Surgery at PAH.

“As a local community-based hospital, we wanted to be more inclusive of the population that we serve, which includes Jehovah’s Witnesses. We are now the only cardiac surgical program in Chester County that brings this level of expertise, collaboration, and programmatic coordination for Jehovah’s Witnesses,” shares Chris Aylsworth, MBA, PA-C, chief cardiovascular physician assistant at CCH.

Practice (and More Practice) Makes Perfect

Over a career that has spanned the better part of the last three decades, Furukawa has risen through the ranks of the premier transfusionless heart surgeons in the country.

“In terms of transfusionless cardiovascular surgery, I think he’s the best in this region. He certainly has the most experience,” Ford says. “I consult with Jehovah’s Witness patients all over the country, and his is the only name I give out for cardiovascular surgery. On top of his expertise, he’s also kind, compassionate, and respectful.”

Several years ago, Furukawa made a critical decision that significantly impacted his approach to surgery – and is now guiding how transfusionless heart surgeries will be performed at Chester County Hospital.

“Rather than say that Jehovah’s Witnesses were outside of the norm, I decided all the cardiac surgeries I performed, I was going to approach them as if the patients were Jehovah’s Witnesses,” he says.

“Jehovah’s Witnesses only represented about five percent of the cases at Pennsylvania Hospital at the time, but if we were to only do a Jehovah’s Witness case once in a while, and we had to change the entire team’s practice each time, there would be more room for error.

“So I decided that for every case, we would do all the things necessary to minimize blood transfusions,” he continues. “That would be our new standard of care.”

While Furukawa is a central component of the new transfusionless heart surgery program at Chester County Hospital, caring for the patients is a team effort. Much of his motivation for aiming to approach every heart surgery as a transfusionless procedure was tied to fostering cohesion among his support staff.

“It’s not the actual surgery that’s complex. It’s just the mentality, the culture that needs to be established from the beginning to the end that’s different from conventional circumstances,” he says.

He began assembling and training his support staff at CCH with the help of Robinson and Ford more than a year ago, in April 2020.

“We were excited to expand our cardiac surgical offerings but recognized the challenge in learning the new ways to perform these procedures without transfusions,” Aylsworth shares.

Transfusions are common in cardiac surgery, he adds. “At most institutions, the cardiac surgical service tends to be one of the largest consumers of blood products.” Nonetheless, the team was eager to learn and bring this offering to their patients.

“We’ve spent the last year working toward getting everyone on the same page,” Furukawa says. “There are nuances in the preoperative, interoperative, and postoperative contexts that need to be accounted for.”

After performing several procedures with Furukawa, Aylsworth and the team quickly developed a comfort level with the techniques and methods introduced to help reduce intraoperative blood loss.

“We’re Constantly, Consciously Building Trust”

“Part of what makes our program special is the ability to leverage world-renowned specialists in bloodless medicine, like Dr. Ford and her team, to work collaboratively with Dr. Furukawa to optimize care for the Jehovah’s Witness patient population,” Aylsworth notes.

Program coordinator Joseph Riddick Jr. oversees Ford’s trusted patient care coordinators, the vital links between patient and doctor at the center. Riddick is also the point person and link to preoperative medical optimization for all CCH transfusionless heart surgery patients. Last September, he entered his 22nd year at the center. Respect for patients’ beliefs and wishes permeates all aspects of the care administered there, as it will with Furukawa’s new program at Chester County Hospital. It falls to the coordinators, though, to ensure that understanding is formalized.

Upon diagnosis and the recommendation of surgery, Riddick carefully walks through an extensive documentation process with the patient, explaining medical terminology and the implications of certain procedures and blood fractions, as needed. The process is designed to make clear and formalize the patient’s intent at every phase, before, during, and after their surgery, removing any chance of miscommunication or misinterpretation about the type of care they are or are not willing to receive. Once complete, everything is registered in the patient’s electronic medical record, which is accessible to every health care provider in the Penn Medicine system.

Throughout that process and beyond, Riddick says the patient care coordinators act foremost as an advocate for the patient. “We want to make sure they know they have someone they can count on to respect their wishes and protect their position until they’re discharged,” he says. “We’re constantly, consciously building trust.”

Patients build that trust with Penn Medicine as an entire system. Even those patients who have transfusionless heart surgery at CCH begin their care at Pennsylvania Hospital, where they first meet with Ford, a hematologist. Under her care, patients may undergo treatment to increase their red blood cell production or to manage their bleeding risk prior to surgery.

New Advancements

Furukawa says this unique approach to heart surgery is beneficial to his patients. He is working on improving care for patients in other ways, too.

In conjunction with the transfusionless heart surgeries, Furukawa has been honing a developing approach called Early Recovery After Cardiac Surgery. The goal is straightforward: to put patients in a position where they’re eligible to be discharged sooner after their surgery. Patients who undergo transfusionless surgery are at an advantage in this regard, he says.

“The fewer transfusions we end up doing, the more chances we have for patients to go home sooner,” Furukawa says. “Transfusions can help to a degree, but complications are more prevalent in transfused patients. So it all works together.”