CABG (coronary artery bypass grafting) is associated with a significant risk of blood transfusion, often reported in the 30–50% range in observational studies. This risk arises from surgical blood loss, cardiopulmonary bypass–related coagulopathy, and prolonged operative times. Blood transfusion may increase the risk of infection, immune reactions, and extended recovery.
For Jehovah’s Witness patients, who decline transfusion, these risks create major challenges. Even with blood conservation strategies, bypass surgery remains inherently high-risk in this group.
By contrast, PCI (angioplasty and stenting) is performed through a small wrist or groin puncture, with a very low likelihood of transfusion. Contemporary radial access, meticulous anticoagulation management, vascular closure devices, and intravascular imaging (IVUS/OCT) help minimise bleeding and optimise results—even in complex disease.
Context: These decisions should always be individualised, ideally within a Heart Team discussion that considers coronary anatomy, comorbidities, and patient values.
Why does bypass surgery carry a high risk of transfusion?
Open-chest surgery and cardiopulmonary bypass lead to significant blood loss and coagulopathy, often necessitating transfusion.
Does PCI require a transfusion?
Almost never. With modern radial access and careful technique, transfusion during PCI is very uncommon.
What are the best options for Jehovah’s Witness patients with heart disease?
PCI is often preferred because it can be performed without transfusion while still effectively treating many coronary blockages.
Is PCI as effective as bypass?
For many anatomies, PCI provides excellent long-term results. The best choice depends on lesion complexity (such as SYNTAX score), ventricular function, diabetes, and overall patient profile.
About the Author
Dr Cuneyt Ada is an interventional cardiologist in Sydney with a focus on complex coronary interventions. He specialises in minimally invasive alternatives to bypass surgery, advanced stent technologies, and transfusion-free coronary care for patients, including Jehovah’s Witnesses.