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Cardiac Surgery in HIV Patients: State of the Art
Bobby Yanagawa1, Subodh Verma1, Girish Dwivedi2
1Division of Cardiac Surgery, St Michael's Hospital, Toronto, Ontario, Canada.
Insights
Antiretroviral therapy allows HIV patients to live longer, increasing risks of heart disease. Cardiac surgery outcomes are improving for these patients, necessitating specialized care and safety protocols.
Area of Science:
- Cardiology
- Infectious Diseases
- Surgical Outcomes
Background:
- Combined antiretroviral therapy has transformed HIV management, leading to increased longevity.
- HIV-positive patients now face chronic illnesses, including cardiovascular diseases, as potential treatment side effects.
- Cardiovascular diseases are a significant cause of illness and death in individuals with HIV.
Purpose of the Study:
- To provide an overview of current cardiac surgery outcomes in HIV-positive patients.
- To discuss ethical considerations in the surgical care of this population.
- To outline strategies for protecting surgical teams from HIV transmission.
Main Methods:
- Review of contemporary outcomes of cardiac surgery in HIV-positive patients.
- Examination of ethical issues in patient selection and surgical management.
- Discussion of safety protocols for healthcare professionals.
Main Results:
- A shift towards conventional and durable surgical therapies in HIV-positive patients.
- Improved understanding of cardiac surgery outcomes in this complex group.
- Identification of necessary safety measures for surgical teams.
Conclusions:
- HIV-positive patients are increasingly candidates for diverse cardiac surgical interventions.
- Comprehensive care requires a multidisciplinary heart team approach involving infectious disease specialists.
- Ethical considerations and team protection are crucial for successful surgical outcomes.
Abstract:
The clinical status of HIV infection has changed dramatically with the introduction of combined antiretroviral therapy. Patients with HIV are now living long enough to be susceptible to chronic illnesses, such as coronary disease and nonischemic cardiomyopathy, which can be consequences of the combined antiretroviral therapy treatment itself. Cardiovascular diseases are a major source of morbidity and mortality in HIV-positive patients. Increasingly, such patients might be candidates for the full range of cardiac surgical interventions, including coronary bypass, valve surgery, and heart transplantation. There has been a shift from offering palliative procedures such as pericardial window and balloon valvuloplasty, to more conventional and durable surgical therapies in HIV-positive patients. We herein provide an overview of the contemporary outcomes of cardiac surgery in this complex and unique patient population. We review some of the ethical issues around the selection and surgical care of HIV-positive patients. We also discuss strategies to best protect the surgical treatment team from the risks of HIV transmission. Finally, we highlight the need for involvement of dedicated infectious disease professionals in a multidisciplinary heart team approach, aiming at the comprehensive care of these unique and complex patients.
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