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THE JOURNAL OF CARDIOVASCULAR SURGERY

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

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

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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