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The Journal of Cardiovascular Surgery 2003 February;44(1):55-7

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Off-pump coronary artery bypass grafting in a patient with AIDS, acute myocardial infarction, and severe left main coronary artery disease

Bittner H. B., Fogelson B. G.

Division of Cardiovascular and Thoracic Surgery University of Minnesota, Minneapolis, MN, USA


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A 48-year-­old ­male ­patient ­with ­AIDS pre­sent­ed ­with ­post­infarct ­unstable angi­na, ­decreased ­left ven­tric­u­lar func­tion (EF 35%), sig­nif­i­cant ­left ­main cor­o­nary ­artery dis­ease, ­and ­total occlu­sion of ­the prox­i­mal ­left ante­ri­or descend­ing ­and ­right cor­o­nary arter­ies. In ­order to ­avoid ­the poten­tial immu­no­sup­pres­sive ­effect of car­di­o­pul­mo­nary ­bypass (­CPB) in an ­already com­pro­mised ­host ­with an ­already ­low CD4+ help­er/induc­er T ­cell ­count (180/μL) ­and ­high ret­ro­vi­ral ­load (165,000 cop­ies/mL), ­the appli­ca­tion of beat­ing-­heart tech­nol­o­gy ­and ­off-­pump cor­o­nary ­bypass graft­ing ­was an ­ideal indi­ca­tion. The ­patient under­went suc­cess­ful­ly ­off-­pump/­CPB cor­o­nary revas­cu­lar­iza­tion. The ­triple ­drug com­bi­na­tion of high­ly ­active anti­ret­ro­vi­ral ther­a­py (­HAART) ­was ­resumed ­postoper­a­tive­ly. The ­patient ­was dis­cahr­ged ­from ­the hos­pi­tal on ­the 7th post­op­er­a­tive ­day. The CD4+ ­count ­was 142/μL ­and ­the ­viral ­load ­decreased to 450 cop­ies/mL. Seven ­months ­post-oper­a­tive­ly ­the ­patient ­was ­free of angi­na ­and with­out short­ness of ­breath. The CD4+ ­count ­was 160/μL ­and ­the ­viral ­load unde­tect­able. Improved sur­vi­val of ­HIV pos­i­tive ­patients ­has result­ed in a ­shift ­from car­ing ­for ter­mi­nal­ly ­ill ­patients to car­ing ­for ­patients ­with chron­ic ill­ness. While pro­tease inhib­i­tors ­have pos­i­tive­ly affect­ed sur­vi­val, ­they ­may ­also ­cause plas­ma lip­id abnor­mal­ities, ­which ­can ­lead to ­severe pre­ma­ture cor­o­nary ­artery dis­ease. Therefore, an increas­ing pop­u­la­tion of ­AIDS ­and ­HIV pos­i­tive ­patients ­with cor­o­nary ­artery dis­ease ­may ­require car­diac inter­ven­tions in ­the ­near ­future. Coronary revas­cu­lar­iza­tion with­out ­CPB ­and ­its poten­tial immu­no­com­prom­is­ing ­effect ­may ­play an impor­tant ­role in ­patients ­with ­severe cor­o­nary ­artery dis­ease ­and ­AIDS.

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