Introduction:

Not transfusing in certain medical settings can be a life-threatening decision; however, Jehovah's Witness patients who reject transfusions have led to learning and multiple medical interventions to avoid it. Despite this, heart surgery follows a specialty that is clearly related to the risk of transfusion, making operating on a Jehovah's Witness patient a challenge.

Case presentation:

An ascending aorta surgery was performed on a Jehovah's Witness patient, where different strategies were applied, both for blood saving and for the prevention and management of coagulopathy.

Results:

Surgery of the ascending aorta with extracorporeal circulation was successfully performed without requiring administration of blood components.

Conclusions:

Adequate planning and implementation of bleeding prevention strategies and coagulopathy management may contribute to avoid and/or reduce the administration of blood products, allowing for the absence of transfusions to not be utopia in major cardiac surgery.

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