[Cardiovascular surgery in patients with HIV: epidemiology, current indications, and long-term outcome]

The new highly active antiretroviral therapies used for the treatment of patients with human immunodeficiency virus (HIV) infection have dramatically modified the natural history of the disease. Although these therapies may themselves have adverse cardiovascular side-effects, their use has also resulted in seropositive patients surviving long enough to be exposed to the same risk factors as the general population. As a consequence, referrals for cardiovascular surgery have increased.

We carried out a retrospective analysis of 39 consecutive HIV patients who underwent cardiovascular surgery between January 1998 and December 2006.

The patients' mean age was 49+/-10 years and 77% (n=30) were male. The CD4-lymphocyte count was <500 cells/microl in 56% of patients (n=22). The main indications for surgery were endocarditis (n=18, 46%), coronary artery disease (n=12, 31%), and aortic disease (n=5, 13%). The in-hospital mortality rate was 5% (n=2). Postoperative complications included systemic infection (n=2, 5%), stroke (n=1, 3%), kidney failure (n=1, 3%) and respiratory failure (n=5, 13%). Repeat surgery for bleeding was necessary in 2 patients (5%). There were no postoperative complications in 29 patients (72%). After a clinical follow-up period of 8.2 years, the long-term mortality rate was 10.8% (4/37), giving survival rates at 1, 3 and 5 years of 91%, 86% and 81% respectively.

Cardiovascular surgery can be performed with complete safety in HIV patients, and with promising results. This study indicates that, currently, long-term survival in this particular group of patients is potentially greater than 80%.