The impact of HIV on 30-day survival amongst patients undergoing cardiac surgery at Groote Schuur Hospital in the ART era

Introduction: The impact of HIV on the one-month perioperative morbidity and mortality in patients undergoing cardiac surgery in sub-Saharan Africa (SSA) in the AntiRetroviral Therapy (ART) era is not known. Pre ART era data from South Africa suggested that patients with a CD4 count less than 400 should be selected with caution. European and North American information suggest that short and long-term outcomes of cardiac surgery in patients with HIV on ART are acceptable, but this experience cannot be generalized to the SSA where demographic profiles, co-morbidities and underlying cardiac pathology requiring surgery is significantly different. Methods: We set out to conduct a retrospective review of the Groote Schuur Hospital and Chris Barnard Division of Cardiothoracic Surgery patient records between 2003 and 2013, to evaluate the perioperative and one month outcomes of HIV positive patients undergoing cardiac surgery at our tertiary care institution. Eighty-one patients met all our study inclusion criteria. Findings: The patient cohort were young, (mean age 34), female (73%) and predominantly black (83%), 41% were on ART, 28% had previous tuberculosis and the average CD4 count was 426.5 cells/μL. Of the 81 patients 54 (67%) underwent valve surgery, 5 (6%) underwent CABG and 3 (4%) had both. Five (6%) patients died in hospital prior to discharge. Bleeding requiring transfusion was the most common complication (n=14; 17.3%) with 2 (2.5%) requiring relook. Other complications included wound sepsis in 9 (11%), complete heart block in 5 (6%), acute kidney injury in 4 (5%), hospital-acquired pneumonia in 3 (4%), cardiac tamponade in 3 (4%) and only one (1%) needlestick injury was reported. The predictors of death included the need for aortic root replacement and prolonged cardiopulmonary bypass time (OR 25 [p=0.006] and OR 1.02 [p= 0.01] respectively) Conclusion: HIV positive patients had cardiac surgical outcomes with low mortality rates comparable to international trends which were independent of CD4 counts. Perioperative complications rates were slightly higher than anticipated.

Grantor

Department of Medicine

Year dc:date.issued

2020

Author dc:creator

• Boloko, Linda

Advisors dc:contributor.advisor

• Ntsekhe, Mpiko
• Pennel, Tim

• Medicine

Handle dc:identifier.uri

http://hdl.handle.net/11427/32602

OAI identifier oai:identifier

oai:open.uct.ac.za:11427/32602