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

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 strategy 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.