Cardiac surgery in patients with human immunodeficiency virus infection: indications and results

Cardiac surgery in three patients infected with the human immunodeficiency virus

Human immunodeficiency virus infection (HIV) is the fourth leading cause of death worldwide.1 Recently, the introduction of highly active antiretroviral therapy (HAART) improved the survival rate of HIV-infected patients. However, the number of HIV-infected patients to be referred for cardiac surgery will increase because cardiovascular risk is increased with the use of HAART. Herein, we report three HIV-infected patients who underwent open heart surgery with cardiopulmonary bypass; we followed their progress by monitoring their CD4+ T-lymphocyte counts. Based on our experience, it seems that cardiopulmonary bypass does not accelerate progression of HIV disease.

Excellent Outcomes of Cardiac Surgery in Patients Infected with HIV in the Current Era

Over the past decade, significant advances have been made in the medical treatment of patients with human immunodeficiency virus type 1 infection, leading to a steady increase in referrals for cardiac surgery. We report the outcome of cardiac surgery recently performed in patients with documented human immunodeficiency virus type 1 infection.

AIDS and heart disease: Is cardiac surgery justified?

A compromised immune system, limited survival and increased risk to the anaesthetic and surgical team of acquiring HIV infection have been the major concerns in offering cardiac surgery to patients with AIDS. The current report presents a patient with AIDS who underwent successful, uncomplicated coronary artery surgery. He remains free of ischaemic and any infective symptoms 12 months postoperatively.

Successful coronary artery bypass surgery in a patient with AIDS

We report the case of a 47-year-old man with AIDS who underwent a successful quadruple coronary artery bypass operation. The improving prognosis of patients with HIV/AIDS, in addition to the reported incidence of plasma lipid abnormalities in patients receiving protease inhibitors, are laying the groundwork for a larger population in which premature coronary artery disease develops. Operative risk, immunosuppressive effect of cardiopulmonary bypass, and practical considerations in the care of these patients are discussed.

Coronary artery bypass grafting in patients with human immunodeficiency virus

The role of surgery in the natural history of HIV disease is in evolution. A review was conducted of 2980 CABG operations taking place between January 1992 and January 1996 at St. Vincents Hospital; four of these patients were known to be HIV-positive prior to the operation. Preoperative work-up, operative course, and postoperative events were largely unremarkable. Only 1 of the 4 patients required rehospitalization within 30 days. Follow-up averaged 28 months (range 7-49 months). Three of four patients were in NYHA Class II or better at follow-up. Other reviews of CABG performed on HIV+ patients also indicate that, although CPB can be linked with immune suppression, there is no conclusive evidence of the acceleration of HIV into AIDS associated with CPB. In conclusion, due to the lack of controlled trials and large patient reviews, no firm recommendations about the effect of CPB on immunocompromized patients can be generated.