HIV-Infected Patients Referred for Cardiac Surgery and Indications for Surgery

In most cardiac centers, 0.2-0.4% of cardiac surgeries are performed on HIV-infected patients, a relatively rare but increasing situ­ation [4, 5] (La Pitie experience). The routine use of antiretroviral therapies has led direct­ly to dramatic declines in morbidity and mor­tality among HIV-1-infected patients with advanced immunodeficiency [6].

During the last 10 years, the profile of HIV- infected patients referred for cardiac surgery in Western countries has changed. These patients are still young—41 years old for Tra- chiotis et al. [7], 36 years old for Mestres et al. [8], 44 for Abad et al. [4]—the majority are men (100% for Abad et al. [4]), frequent­ly drug addicts or homosexual, but there is also an increasing proportion of women and older patients. At La Pitie, only 1 of 22 patients (4.5%) operated on during the 1990s was a woman; since the beginning of 2000, 5 of 27 patients (14.8%) operated on have been women.

The indications for cardiac surgery in HIV- infected patients have increased and changed for three reasons. First, the survival is greater and HIV-infected patients are exposed for longer periods to specific and classic cardiac lesions requiring surgery. Sec­ond, HAART itself is suspected to induce specific cardiac lesions, particularly coro­nary artery disease. Third, because the HIV infection is controlled with a long survival, we can consider complex therapeutic strate­gies in these patients such as heart trans­plantation and soon artificial hearts. Figure 1 reports the increasing number of coronary artery bypass grafting in HIV-infected patients during the last 6 years at La Pitie Institute. Because of the epidemiological profile of the HIV-infected population in Western countries in the HAART era, the major indications for cardiac surgery are coronary artery disease and cardiomyopathy.