High-Risk Cardiac Surgery in Patients with Intravenous Drug Abuse and/or Active Hepatitis C or HIV Infection: An Ethical Discussion of Six Cases

Gansera, Laura; Eszlári, E.; Deutsch, Oliver; Eichinger, Walter; Gansera, Brigitte

doi:10.1055/s-0035-1551682

Cited by 17 publications

(15 citation statements)

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“…[6,7] Hepatitis C co-infection poses numerous problems; in addition to long-term risks such as liver cirrhosis and cancer, and transmission of infection to others, it also presents ethical dilemmas with regard to surgery in IDUs. [8,9] In addition, significant costs are associated with the treatment of hepatitis C infection, often in non-compliant patients, who frequently have other concurrent opportunistic infections associated with HIV. [10] In agreement with previous literature on IE in IDUs, the majority of the patients in this study were HIV-positive.…”

Section: Discussionmentioning

confidence: 99%

Striking increase in the incidence of infective endocarditis associated with recreational drug abuse in urban South Africa

Meel

Essop

2018

S Afr Med J

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Section: Discussionmentioning

confidence: 99%

Striking increase in the incidence of infective endocarditis associated with recreational drug abuse in urban South Africa

Meel

Essop

2018

S Afr Med J

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“…An important recent study of surgical outcomes for isolated IVDU-associated tricuspid valve infective endocarditis, utilizing The Society of Thoracic Surgeons (STS) adult cardiac surgery database, and using a contemporary cohort of patients demonstrates that valvectomy was an independent predictor of operative mortality (14). Prior reports have demonstrated that long-term survival without a tricuspid valve is feasible (up to 22 years) in the context of normal pulmonary artery pressures and/ or pulmonary vascular resistance (11,15). The lack of significant differences in perioperative outcomes, coupled with high prosthetic valve infection and readmission rates seen in patients treated with valve replacement at their initial operation, helps to establish tricuspid valvectomy as a useful bridge to staged valve replacement in this highrisk patient population.…”

Section: Random Effects Modelmentioning

confidence: 99%

“…The decision of choice and whether to offer surgical therapy for patients with IVDU-associated infective tricuspid valve endocarditis is a complex one-with social considerations (willingness to abstain from IVDU, compliance with antibiotic therapy stable income, stable housing, detoxification and rehabilitation), clinical considerations (size of vegetations, extension of abscess, comorbid HIV and hepatitis C infection) and ethical considerations (prolong life expectancy, risk of recurrence, healthcare expenditures and resource allocation) (15). IVDU is an independent predictor of death in patients with endocarditis and should be considered strongly in surgical recommendations for this complicated population (1,13,17).…”

Section: Random Effects Modelmentioning

confidence: 99%

Valvectomy versus replacement for the surgical treatment of infective tricuspid valve endocarditis: a systematic review and meta-analysis

Luc¹,

Choi²,

Kodia³

et al. 2019

Ann. Cardiothorac. Surg.

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Background: Optimal surgical treatment of infective tricuspid valve endocarditis in patients with intravenous drug use (IVDU) remains controversial. Tricuspid valvectomy has been proposed for infective tricuspid valve endocarditis in this patient population given the inherent social concerns. The aim of this systematic review and meta-analysis was to compare outcomes of valvectomy versus replacement for the surgical treatment of isolated infective tricuspid valve endocarditis. Methods: An electronic search was performed to identify all relevant studies published. After assessment for inclusion and exclusion criteria, 16 original studies were pooled for systematic review and meta-analysis. Results: There were a total of 752 patients with infective tricuspid valve endocarditis, of which 14% underwent valvectomy and 86% underwent replacement (mean follow-up 4.2 years, 95% CI, 1.9-6.4 years). The most common indications for surgical intervention were septic pulmonary embolism in the valvectomy group (74%, 95% CI, 28-95%) and persistent sepsis in the replacement group (62%, 95% CI, 31-86%). There were no differences in rates of stroke [valvectomy 4% (95% CI, 1-11%) vs. replacement 3% (95% CI, 1-16%), P=0.85] but there was increased likelihood of prolonged ventilation in those who underwent valvectomy [valvectomy 40% (95% CI, 30-51%) vs. replacement 26% (95% CI, 23-30%), P<0.01]. There were no differences in 30-day post-operative mortality [valvectomy 13% (95% CI, 5-30%) vs. replacement 7% (95% CI, 5-10%), P=0.21], post-operative right heart failure [valvectomy 27% (95% CI, 10-53%) vs. replacement 11% (95% CI, 5-25%), P=0.17] and recurrent endocarditis [valvectomy 7% (95% CI, 2-23%) vs. replacement 19% (95% CI, 12-28%), P=0.81]. Valvectomy had a higher rate of tricuspid valve reoperation [valvectomy 56% (95% CI, 15-90%) vs. initial replacement 14% (95% CI, 7-27%), P=0.06]. Conclusions: Tricuspid valvectomy is an acceptable initial therapy for infective tricuspid valve endocarditis in patients with IVDU, providing a bridge to identify those who will self-select as candidates for staged valve replacement.

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“…One of the most painful issues reported by our participants was surgery for patients with HIV, which they were refused by hospitals, by specialists and medical staff. Gansera et al (2016) in a study in Germany, reported that there is support for not performing cardiac surgery in patients with hepatitis C and HIV infection and a number of patients reported that some hospitals refused to admit them (13). A qualitative study by Gwala-Ngozo et al in 2010 held individual interviews with 15 physicians about performing surgery and found four areas of concern in the experiences of surgeons regarding performing surgery on patients with HIV/AIDS: personal factors, patient factors, factors related to the structure of the health system, and factors related to the treatment protocol of patients with HIV/AIDS.…”

Section: Discussionmentioning

confidence: 99%

I am HIV-positive, but I am a human being: qualitative study on experiences of stigma in health care centres in the Islamic Republic of Iran

Abedinia¹,

Rasoolinajad²,

Noorbala³

et al. 2019

East Mediterr Health J

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Background: People living with HIV can have many health problems and may face difficulties when seeking health care because of stigma and the inappropriate behaviour of health care staff. Aims: This study aimed to assess the problems people living with HIV face when seeking health care in the Islamic Republic of Iran. Methods: A qualitative study was conducted with 10 people living with HIV who were members of the positive fellowship club of the Imam Khomeini Hospital in Tehran, Islamic Republic of Iran. Participation was voluntary. Using a focus group discussion, the participants talked about the problems they faced when seeking health care in different health departments and clinics. Data were analysed using inductive content analysis. Results: The participants faced many problems in all health departments and clinics when seeking health care. The most important problems were: 1) refusal of treatment in outpatient, medical and surgical departments; 2) inappropriate behaviour of consultants and medical staff; and 3) insufficient knowledge of medical staff about HIV and how it is transmitted. Conclusions: Providing medical and health care staff with more information on HIV and its transmission, training them on proper treatment and management of patients with HIV, and providing free treatment packages and medical services for people living with HIV may help reduce the stigma and problems HIV patients face when seeking health care, and improve the care they receive.

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High-Risk Cardiac Surgery in Patients with Intravenous Drug Abuse and/or Active Hepatitis C or HIV Infection: An Ethical Discussion of Six Cases

Abstract: Decision making in noncompliant drug addicts with recurrent prosthesis infection and in HIV-positive patients leads beyond surgical challenges to ethical and economic considerations.

Cited by 17 publications

References 0 publications

Striking increase in the incidence of infective endocarditis associated with recreational drug abuse in urban South Africa

Striking increase in the incidence of infective endocarditis associated with recreational drug abuse in urban South Africa

Valvectomy versus replacement for the surgical treatment of infective tricuspid valve endocarditis: a systematic review and meta-analysis

I am HIV-positive, but I am a human being: qualitative study on experiences of stigma in health care centres in the Islamic Republic of Iran

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