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Ann Thorac Surg 2003;76:478-481
© 2003 The Society of Thoracic Surgeons

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Original article: cardiovascular

Cardiac valve replacement in human immunodeficiency virus–infected patients

^a Division of Cardiac Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA

^* Address reprint requests to Dr Cameron, Division of Cardiac Surgery, Blalock 618, The Johns Hopkins Hospital, 600 North Wolfe St, Baltimore, MD 21287, USA
e-mail: dcameron{at}jhmi.edu

Presented at the Forty-eighth Annual Meeting of the Southern Thoracic Surgical Association, San Antonio, TX, Nov 8–10, 2001.

BACKGROUND: Valve replacement in human immunodeficiency virus (HIV)-infected patients is being performed with increasing frequency, but the early and late results in these immunocompromised patients are not known.

METHODS: A 10-year retrospective clinical review was undertaken; patients and their physicians were contacted for follow-up clinical status.

RESULTS: Twenty-two HIV-infected patients underwent valve replacement between 1990 and 1999, with no operative or hospital deaths. Mean patient age was 37.6 years; 15 were men. Indications for operation were heart failure in 59% (13/22) and sepsis in 91% (20/22). There were 12 aortic valve replacements, seven mitral valve replacements, and three double valve replacements. Mechanical valves were used in 11, bioprostheses in seven, and homografts in four. Follow-up information was available in 20 of 22 patients (84%). At mean follow-up of 5 years, there were 10 late deaths, due to: intracerebral hemorrhage (2), heart failure (2), unknown cause (2), renal failure (1), AIDS (1), sepsis (1) and endocarditis (1). Of the 20 patients with active preoperative endocarditis, 4 (20%) developed recurrent endocarditis; freedom from recurrent endocarditis was 83% at 1 year. Intravenous drug abuse was reported in 16 patients; survival among these patients was 94% at 1 month and 50% at 5 years. Recurrent endocarditis was only seen in patients with continued intravenous drug abuse.

CONCLUSIONS: Valve replacement in HIV-infected patients has low operative risk, but late results are poor when HIV infection is associated with intravenous drug abuse, probably due to immunocompromise and continued high-risk behavior.

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