Long-term results after cardiac surgery in patients infected with the human immunodeficiency virus type-1 (HIV-1)

Abstract

There is an increase in HIV-1-infected patients requiring cardiac surgery, a decrease in AIE, however NIVD and CAD increasingly seen. Cardiac surgery did not blunt CD4 response induced by antiretrovirals. The late cause of death were not AIDS-related events.

Type I aortic dissection in a patient with human immunodeficiency virus infection

“…One study indicates that perioperative morbidity and mortality rates are high in HIV patients undergoing abdominal aortic surgery (17). HIV infection itself does not seem to increase perioperative morbidity and mortality in cardiac surgery and major cardiac surgery does not negatively affect the course of HIV infection (18). Once the acute dissection has healed, adequate control of blood pressure may eliminate the need for surgery.…”

Human Immunodeficiency Virus disease and cardiac surgery – where are we?

“…Mestres et al, (13) in 2003, following an initial report (Miro et al, (14) ) reviewed long-term outcome in 31 HIV patients, 24 being IVDAs, in their detailed paper. Mortality related to AIE was 23.4% (Table 1).…”

“…(13,19) They considered it practical to offer HIV+ as well as AIDS patients cardiac surgery with expectation of a good outcome, in view of the longer life expectancy related to ART usage.…”

“…(Table 2) Everson Uip (12) Occasional case reports of CABG in patients with AIDS on and off-pump, on PI showed good results, but alluded to the expectation of increased premature coronary artery disease with increase in age and use of PI. (13,(20)(21)(22)(23) Trachiotis et al (15) (2003) reported on 27 isolated CABGs, 3 offpump; the largest detailed series which also included 10 valve procedures, 2 with CABG. Thirty-three percent of the CABG versus 40% of the valve patients had displayed AIDS-defi ning features, the latter having statistically higher mean viral loads (VL).…”

“…The initial one concerning further depression of the immune system by cardiac surgery and CPB was clear some years ago: depression caused is transient (5,6) and even those patients with advanced disease tolerate surgery well. (2,4,(7)(8)(9)13,17,20,23) HIV disease is recognised as a chronic disease and even without ARV therapy, life expectancy from time of seroconversion is at least 10 years. Acceleration of disease progression in relation to cardiac surgery has not been shown.…”