[Mortality and morbidity in HIV-infected patients undergoing coronary artery bypass surgery: a case control study]

Area of Science:

• Cardiology
• Infectious Diseases
• Surgical Outcomes

Background:

• Highly active antiretroviral therapy (HAART) has improved survival in HIV-infected patients.
• Treatment-related metabolic effects increase cardiovascular risk in HIV patients, necessitating cardiac surgery.
• Limited data exists on the outcomes of coronary artery surgery in HIV-infected individuals.

Purpose of the Study:

• To compare morbidity and mortality in HIV-infected and non-HIV-infected patients undergoing isolated coronary artery surgery.
• To evaluate the safety and efficacy of coronary artery surgery in the context of HIV infection.

Main Methods:

• Retrospective case-control study comparing 7 HIV-infected patients with 21 non-HIV-infected controls.
• Patients underwent isolated coronary artery surgery between 1997 and 2004.
• Outcomes assessed included procedural times, complication rates, hospitalization duration, and mortality.

Main Results:

• HIV-infected patients had significantly shorter durations of extracorporeal circulation (P=.002) and aortic cross-clamping (P=.014).
• Overall complication rates were similar (57.1% in both groups), with a trend towards fewer complications per patient in HIV-infected individuals.
• No HIV-infected patient died or required repeat cardiac surgery; no HIV progression was observed.
• Hospitalization duration was longer for HIV-infected patients (total: 27.1 days vs 8.8 days; postoperative: 18.2 days vs 7.9 days).

Conclusions:

• Isolated coronary artery surgery in HIV-infected patients yields good results with no increased morbidity or mortality.
• Extracorporeal circulation did not appear to influence HIV disease progression.
• Coronary artery surgery is a viable option for selected HIV-infected patients with cardiovascular disease.