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Cardiac surgery safe for patients with HIV

Issue: July 2014

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TORONTO — Cardiac surgery can be performed safely in patients with HIV, without an increase in hospital mortality, new data suggest.

“Patients with HIV can safely undergo cardiovascular operations, and their outcomes are good, similar to patients without HIV,” Michael P. Robich, MD, from the department of thoracic and cardiovascular surgery, Heart and Vascular Institute, Cleveland Clinic, said during a presentation at the American Association for Thoracic Surgery Annual Meeting. “As time goes on, we will see more and more of these patients. We should operate on them as we would an HIV-negative patient.”

Robich and colleagues conducted a retrospective study of 5,621,817 cardiac surgeries performed between 1998 and 2009. According to Robich, 9,771 of the surgical patients had HIV.

Michael P. Robich

With the introduction of antiretroviral therapy, the longevity of patients with HIV has been positively affected, and more patients are developing other diseases and requiring cardiac surgeries, Robich said.

Results showed a significant increase in the percentage of HIV-positive patients who underwent cardiac surgery during the study period, from 0.09% to 0.23%.

Hospital mortality did not differ between the two groups (P=.915). Factors predictive of in-hospital mortality among patients with HIV included metastatic cancer; coagulopathy; renal failure; and aortic, other or combined surgical procedure. However, patients with HIV were more likely to experience complications of surgery (38.5% vs. 29.6%; P<.001). Stroke was more common in patients without HIV (2.3% vs. 1.2%; P<.001).

The researchers noted that they did not observe dissimilar rates of pneumonia (P=.086) or wound infections (P=.313) between the two groups. “We would have expected [the HIV-positive patients] to have higher rates [of infection],” Robich said.

Patients with HIV had a greater need for postoperative blood transfusions (P=.047). This finding was anticipated, according to Robich.

The researchers also determined risk-adjusted outcomes and found that patients with HIV stayed in hospital 1 day longer than patients without HIV (8 vs. 7 days; P=.06). In addition, the median total cost of hospital stay was similar regardless of HIV status (HIV: $32,413; no HIV: $31,125; P=.7).

Patients with HIV were more likely to be male, black, younger than 55 years and have Medicaid insurance. In addition, these patients were less likely to undergo CABG and more likely to undergo valve and other CV surgeries. – by Louise Gagnon

For more information:

Robich MP. Abstract #31. Presented at: American Association for Thoracic Surgery Annual Meeting; April 26-30, 2014; Toronto.

Disclosure: Robich reports no relevant financial disclosures.