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Eur J Cardiothorac Surg 2003;23:1007-1016
© 2003 Elsevier Science NL

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

^a Department of Cardiovascular Surgery, Hospital Clínico, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
^b Infectious Diseases Service-Institut Clinic Infeccions Inmunologia (ICII), Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
^c Hospital de Basurto, Bilbao, Spain

Received 27 October 2002; received in revised form 10 March 2003; accepted 11 March 2003.

^* Corresponding author. Tel.: +34-93-227-5515; fax: +34-93-451-4898
e-mail: cmestres{at}clinic.ub.es

Objectives: Assessment of long-term results of immunodeficiency virus type-1 (HIV-1)-infected patients undergoing cardiac surgery. Methods: Retrospective analysis of profile and outcomes of 31 HIV-1-infected patients (35 operations, 1985–2002). Results: Twenty-seven males and four females (mean age 34.67) in three groups: acute infective endocarditis (AIE) 21 (67.74%), coronary (CAD) 5 (16.13%) and non-infective valvular disease (NIVD) 5 (16.13%). HIV factors: drug addiction (23–74.19%), homosexuality (5–16.12%), heterosexuality (3–9.67%), hemodialysis (1–3.22%). HIV stage: A (17), B (2), C (2) in AIE; A (2), B (3) in CAD and A (3), C (2) in NIVD. Mean preoperative CD4 count was 278 cells/µL (12<200 cells/µL, 38.7%). The most frequent pathogens: S. aureus (52.38%), S. viridans (23.8%), Candida (19.04%). Native valve involved in 22 cases (78.33%) and prostheses in 8 (26.67%); 8.57% were operated in 1980–1985, 14.28% in 1986–1990, 22.85% in 1991–1995 and 54.28% in 1996–2002 with 16 elective (48.17%), 17 urgent (45.71%) and two emergencies (5.71%); mean aortic clamping and cardiopulmonary bypass time 78.9 and 107.47 min. Hospital mortality was 22.58 and 28.57% in AIE. No CAD patient died. Nine patients (37.5%) died between 2 and 171 months (mean 54.5). Mortality was 50% in AIE. CD4 count increased from 185.33 to 396.55 cells/µL (P=0.43) in nine patients on antiretrovirals. Fifteen-year actuarial survival is 58.16% overall and 48.01% for AIE. Conclusions: 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.

Key Words: Cardiac surgery • Human immunodeficiency virus • Endocarditis • Intravenous drug abusers • Homosexuality • Antiretroviral therapy

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