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Cardiac surgery in patients infected with human immunodeficiency virus
C Abad1, M A Cárdenes, P C Jiménez
1Department of Cardio-Vascular Surgery, University Hospital de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain.
Insights
Cardiac surgery can be beneficial for select patients with human immunodeficiency virus (HIV). However, these individuals face higher risks, with valvular endocarditis being a common complication requiring surgical intervention.
Area of Science:
- Cardiology
- Infectious Diseases
- Surgical Oncology
Background:
- Human immunodeficiency virus (HIV) infection impacts various organ systems, including the cardiovascular system.
- Cardiac complications in HIV patients, such as infectious endocarditis and pericardial disease, necessitate surgical consideration.
Purpose of the Study:
- To evaluate the outcomes of cardiac surgery in patients with HIV.
- To identify common cardiac conditions requiring surgery in this population.
Main Methods:
- A retrospective review of 5 consecutive HIV-infected patients undergoing cardiac surgery between January 1991 and December 1999.
- Surgical procedures included valve replacement, aortic aneurysm repair, and pericardial drainage.
Main Results:
- No intraoperative mortality was observed.
- Hospital mortality was 20% (1 of 5 patients), with late deaths at 2 and 63 months.
- Two patients who underwent double valve replacement showed good long-term outcomes.
Conclusions:
- Cardiac surgery is a viable option for carefully selected HIV-infected patients.
- Valvular endocarditis is a frequent indication for surgery in this cohort.
- HIV patients undergoing cardiac surgery exhibit elevated morbidity and mortality rates.
Abstract:
From January 1991 through December 1999, 5 consecutive patients who were infected with human immunodeficiency virus presented in need of cardiac surgery. All were men; the median age was 44 years. Two of them presented with mitral and aortic infectious valve endocarditis, 1 with tricuspid endocarditis, 1 with prosthetic valve endocarditis, and 1 with pericarditis and pericardial tamponade. Under cardiopulmonary bypass, the 4 patients with endocarditis underwent these procedures: mitral and aortic valve replacement (2), tricuspid valve replacement (1), and aortic valve replacement (reoperation) and concomitant repair of a mycotic ascending aortic aneurysm (1). In the patient who had pericardial effusion, subxifoid pericardiostomy and drainage were performed, and a pericardial window was created. There was no intraoperative mortality. The patient with pericardial effusion died 8 days after surgery; he was in septic shock and had multiple organ failure. Two deaths occurred at 2 and 63 months, due to hemoptysis and sudden death, respectively. The 2 patients who underwent double valve replacement are alive and in good condition after a median follow-up of 71 months. Cardiac surgery is indicated in selected patients infected by the human immunodeficiency virus. These patients are frequently drug abusers or homosexual. Valvular endocarditis is the most common finding. Hospital morbidity and mortality rates are higher than usual in this group of patients.