Cardiopulmonary bypass in HIV-positive patients

Arı́s, Anna; Pomar, J.; Saura, E

doi:10.1016/0003-4975(93)90015-a

Cited by 39 publications

(19 citation statements)

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“…Preoperative treatment for active HIV infection or obvious immune impairment is desirable especially in cases that need CPB. As CPB does not seem to affect the status of HIV infection, 7,8 we believe that the combination of cardiovascular surgery with perioperative HAART will become the standard strategy for patients with advanced HIV infection. Of course, catheter intervention or off-pump procedures can be good alternatives when indicated.…”

Section: Discussionmentioning

confidence: 98%

Coronary Artery Bypass Grafting in a Patient With Human Immunodeficiency Virus

et al. 1999

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Section: Discussionmentioning

confidence: 98%

Coronary Artery Bypass Grafting in a Patient With Human Immunodeficiency Virus

et al. 1999

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“…Arbulu et al [57], in a cohort of 54 IVDA undergoing surgery for right-sided IE, found a survival rate of 64% at 22 years. Aris et al [53] studied 40 HIV-infected patients (mostly IVDA with IE) undergoing cardiopulmonary bypass, and the probability of survival at 1, 3, and 5 years was 70%, 60%, and 48%, respectively. These studies were performed before the HAART era (before 1996) and currently the HIV prognosis with HAART is much better.…”

Section: Advances In the Surgical Treatment Of Infective Endocarditismentioning

confidence: 98%

Infective endocarditis in intravenous drug abusers

Miró

Moreno²,

Mestres³

2003

Curr Infect Dis Rep

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Infective endocarditis (IE) is one of the most severe complications in intravenous drug abusers (IVDA). IE usually involves the tricuspid valve, Staphylococcus aureus is the most common etiologic agent, and it has a relatively good prognosis. Currently, between 40% and 90% of IVDA with IE are HIV infected, and the HIV epidemic has caused a decrease in the incidence of this disease, probably due to changes in drug administration habits undertaken by addicts in order to avoid HIV transmission. This review focuses on progress made over the past few years in some aspects of IE in IVDA. The pathogenesis of tricuspid endocarditis is still unknown more than 60 years after the first series. The most important advance in antibiotic therapy is that noncomplicated S. aureus right-sided endocarditis can be successfully treated with an intravenous 2-week course of nafcillin or cloxacillin plus an aminoglycoside, although probably the aminoglycoside administration could be stopped after the first 3 to 5 days. Surgery in HIV-infected IVDA with IE does not worsen the prognosis. Considering the possibility of reinfection in IVDA, prosthetic material is usually avoided. Tricuspid valvulectomy or valve repair should be considered the technique of choice in IVDA with right-sided IE. Replacement of the tricuspid valve by a cryopreserved mitral homograft is the latest introduction into clinical practice. It provides atrioventricular competence, thereby avoiding late right heart failure. Reinfections can be treated medically with a negligible reoperation rate. Overall mortality for HIV-infected or non-HIV-infected IVDA with IE is similar. However, among HIV-infected IVDA, mortality is significantly higher in those who are most severely immunosuppressed, with CD4(+) cell counts below 200/L or with AIDS criteria.

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“…However, surgical intervention does not worsen the short-term prognosis of HIV infection. [21][22][23] Response to antibiotic therapy was similar in both groups. Recent studies in HIV-infected IV drug users with right-sided IE caused by S aureus have shown very good response rates to 2-week courses of cloxacillin sodium (with or without gentamicin sulfate) 7 and to oral combinations of ciprofloxacin hydrochloride and rifampin.…”

Section: Commentmentioning

confidence: 99%