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Canadian Journal of Cardiology

Cardiac Surgery in HIV Patients: State of the Art

Published:November 19, 2018DOI:https://doi.org/10.1016/j.cjca.2018.11.006

      Abstract

      The clinical status of HIV infection has changed dramatically with the introduction of combined antiretroviral therapy. Patients with HIV are now living long enough to be susceptible to chronic illnesses, such as coronary disease and nonischemic cardiomyopathy, which can be consequences of the combined antiretroviral therapy treatment itself. Cardiovascular diseases are a major source of morbidity and mortality in HIV-positive patients. Increasingly, such patients might be candidates for the full range of cardiac surgical interventions, including coronary bypass, valve surgery, and heart transplantation. There has been a shift from offering palliative procedures such as pericardial window and balloon valvuloplasty, to more conventional and durable surgical therapies in HIV-positive patients. We herein provide an overview of the contemporary outcomes of cardiac surgery in this complex and unique patient population. We review some of the ethical issues around the selection and surgical care of HIV-positive patients. We also discuss strategies to best protect the surgical treatment team from the risks of HIV transmission. Finally, we highlight the need for involvement of dedicated infectious disease professionals in a multidisciplinary heart team approach, aiming at the comprehensive care of these unique and complex patients.

      Résumé

      Le statut clinique de l’infection par le VIH a évolué de façon spectaculaire avec l’avènement du traitement antirétroviral combiné. Les patients infectés par le VIH ont à présent une espérance de vie assez longue pour pouvoir être atteints de maladies chroniques comme la coronaropathie et la cardiomyopathie non ischémique, qui peuvent être la conséquence du traitement antirétroviral combiné lui-même. Les maladies cardiovasculaires sont une cause majeure de morbidité et de mortalité chez les patients séropositifs pour le VIH. De plus en plus, ces patients pourraient être candidats à l’une des interventions de l’éventail complet des chirurgies cardiaques, y compris le pontage coronarien, la chirurgie valvulaire et la transplantation cardiaque. L’approche consistant à proposer aux patients séropositifs pour le VIH des interventions palliatives comme la fenêtre péricardique et la valvuloplastie par ballonnet a été abandonnée au profit de modalités plus classiques et plus durables. Dans le présent article, nous présentons une vue d’ensemble actualisée des résultats de la chirurgie cardiaque dans cette population de patients complexe et unique. Nous examinons certains des enjeux éthiques entourant la sélection et les soins chirurgicaux des patients vivant avec le VIH. Nous abordons également la question des stratégies visant à protéger au mieux l’équipe d’intervention chirurgicale contre le risque de transmission du VIH. Enfin, nous soulignons la nécessité de privilégier l’approche de l’équipe de cardiologie interdisciplinaire à laquelle seraient intégrés des professionnels spécialistes des maladies infectieuses, avec pour objectif d'offrir tout l’éventail des soins à ces patients uniques et complexes.
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