Cardiac surgery and the human immunodeficiency virus

Since the first deliberate open heart operation was performed on a patient known to be carrying HIV, much has been learned. The fear that cardiopulmonary bypass might cause acceleration of the disease has not been borne out. Patients infected with HIV have shown considerable tolerance to major cardiac and pulmonary surgery. Indeed, the extraordinary fruits of a massive research effort have made it reasonable to perform elective surgery and to offer major surgery to patients with the full-blown syndrome of AIDS. The concern that the operators would be exposed to significant risk of acquiring the infection during surgery has proved to be unfounded. This has been in part due to the widespread adoption of universal precautions against the passage of microorganisms from patient to operator. However, there remain surgeons who ignore these precautions. The price they pay is the risk of acquiring hepatitis, which is far more easily transmitted than AIDS and may be fatal.