Jehovah’s Witness (JW) patients refuse blood transfusion on religious grounds, posing challenges to cardiac surgeons. While Western centers report comparable outcomes to non JW patients, data from Asia—particularly Japan—are scarce. This single-center retrospective study evaluated 50 JW patients undergoing open cardiac surgery between 2014 and 2024. High-risk cases, including acute aortic dissection, redo valve surgeries, and dialysis patients, were included. A structured bloodless protocol guided perioperative care, incorporating preoperative hemoglobin optimization and intraoperative conservation techniques. 

Professor Tatsuya Nakao became President at New Tokyo Hospital, Japan in June. 2023. He has been working as a foreign proctor of arch repair with Frozenix open stent-graft. He has been serving as an Editorial member of ACR(AME Case Reports).