PMID- 17001420 OWN - NLM STAT- MEDLINE DCOM- 20070619 LR - 20221207 VI - 17 IP - 4 DP - 2006 Jul-Aug TI - An experience with cardiopulmonary bypass in HIV-infected patients. PG - 178-85 AB - Having noted the good clinical status of some HIV patients who were referred for but refused surgery, we undertook surgery with the aim of determining outcome, risk-to-benefit ratio and, if possible, the effect of surgery with cardiopulmonary bypass (CPB) on the progression of their HIV disease. Antiretroviral drugs (ARVD) were not available to these patients. The records of 49 patients, 17 males and 32 females, aged between 17 and 67 years, undergoing surgery with cardiopulmonary bypass over a nine-year period, were reviewed. Forty-eight of these underwent cardiac surgery and one aortic dissection repair. Four HIV-infected patients underwent surgery with good early outcome. Thereafter an absolute CD4 cell count greater than 400/microl (normal 550*1 955/microl) and the absence of the stigmata of AIDS in patients fulfilling the normal criteria for surgery allowed cardiac surgery using CPB. Fifty operations were performed. Three patients with CD4 counts of 37, 868 and 1 245/microl died early, giving a 30-day mortality of 6% for 50 procedures. Six patients with active infective endocarditis (IE) underwent emergency surgery. Three of these, one with a pre- and two with only post-operative counts all below 250/microl, died within three months. Sixteen complications occurred in the remaining 46 patients (34.7%). Pre-operative CD4 cell counts taken in 42 patients averaged 685/microl. Pre- and post-operative counts known in eight showed variations, as did repeated counts in those awaiting surgery. Forty-one patients left hospital in the New York Heart Association (NYHA) class I, five in class II and one in class III. Prior to surgery, the majority (38) were in class III and seven were in class IV. Follow up ranging from two to 70 months averaged 23.1 months. Eight late deaths occurred, three related to AIDS. We found surgery to be worthwhile in selected HIV-infected patients. Early outcome paralleled that in the uninfected, giving a low risk-to-benefit ratio. Emergency surgery in those with active infective endocarditis and marked immune compromise met with high mortality. It is essential in our population to test and stage all patients for HIV. We could not show that CPB accelerated progression to AIDS. This experience and the present availability of ARVDs would enable us to review our selection criteria for surgery. FAU - Blyth, D F AU - Blyth DF AD - HIV Department of Cardiothoracic Surgery, University of KwaZulu-Natal, Durban, South Africa. FAU - Buckels, N J AU - Buckels NJ FAU - Sewsunker, R R AU - Sewsunker RR FAU - Khan, S AU - Khan S FAU - Mathivha, T M AU - Mathivha TM LA - eng PT - Journal Article PL - South Africa TA - Cardiovasc J S Afr JT - Cardiovascular journal of South Africa : official journal for Southern Africa Cardiac Society [and] South African Society of Cardiac Practitioners JID - 100964061 RN - 0 (Biomarkers) SB - IM MH - Adolescent MH - Adult MH - Aged MH - Aortic Dissection/surgery MH - Aortic Aneurysm/surgery MH - Biomarkers/blood MH - CD4 Lymphocyte Count MH - Cardiac Surgical Procedures/adverse effects MH - *Cardiopulmonary Bypass/adverse effects MH - Cardiovascular Diseases/complications/*surgery MH - Disease Progression MH - Female MH - Follow-Up Studies MH - HIV Infections/*complications/immunology MH - Heart Diseases/surgery MH - Humans MH - Male MH - Middle Aged MH - Patient Selection MH - Postoperative Complications/etiology/mortality/surgery MH - Reoperation MH - Risk Assessment MH - Severity of Illness Index MH - South Africa MH - Survival Analysis MH - Time Factors MH - Treatment Outcome EDAT- 2006/09/27 09:00 MHDA- 2007/06/20 09:00 CRDT- 2006/09/27 09:00 PHST- 2006/09/27 09:00 [pubmed] PHST- 2007/06/20 09:00 [medline] PHST- 2006/09/27 09:00 [entrez] PST - ppublish SO - Cardiovasc J S Afr. 2006 Jul-Aug;17(4):178-85.