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Coronary artery bypass grafting in patients with human immunodeficiency virus
D R Flum1, D H Tyras, M K Wallack
1Department of Surgery, St. Vincents Hospital and Medical Center, New York, New York, USA.
Insights
Coronary Artery Bypass Grafting (CABG) surgery in HIV-positive patients showed unremarkable outcomes. Further research is needed to establish the impact of cardiopulmonary bypass (CPB) on immunocompromised individuals.
Area of Science:
- Cardiovascular Surgery
- Infectious Diseases
- Immunology
Background:
- The role of surgical interventions in the management of Human Immunodeficiency Virus (HIV) disease is evolving.
- Coronary Artery Bypass Grafting (CABG) is a significant surgical procedure with implications for patients with pre-existing conditions.
Purpose of the Study:
- To evaluate the outcomes of CABG surgery in patients with HIV.
- To assess the potential impact of cardiopulmonary bypass (CPB) on the progression of HIV disease.
Main Methods:
- Retrospective review of 2980 CABG operations performed between January 1992 and January 1996.
- Analysis of preoperative, operative, and postoperative data for four known HIV-positive patients.
Main Results:
- Surgical outcomes for the four HIV-positive patients were largely unremarkable.
- One patient required rehospitalization within 30 days post-surgery.
- At an average follow-up of 28 months, three of the four patients were in New York Heart Association (NYHA) Class II or better.
Conclusions:
- Current evidence does not conclusively link cardiopulmonary bypass (CPB) with accelerated progression of HIV to AIDS.
- The limited number of studies and patient reviews prevents definitive recommendations regarding CPB in immunocompromised patients.
Abstract:
The role of surgery in the natural history of HIV disease is in evolution. A review was conducted of 2980 CABG operations taking place between January 1992 and January 1996 at St. Vincents Hospital; four of these patients were known to be HIV-positive prior to the operation. Preoperative work-up, operative course, and postoperative events were largely unremarkable. Only 1 of the 4 patients required rehospitalization within 30 days. Follow-up averaged 28 months (range 7-49 months). Three of four patients were in NYHA Class II or better at follow-up. Other reviews of CABG performed on HIV+ patients also indicate that, although CPB can be linked with immune suppression, there is no conclusive evidence of the acceleration of HIV into AIDS associated with CPB. In conclusion, due to the lack of controlled trials and large patient reviews, no firm recommendations about the effect of CPB on immunocompromized patients can be generated.