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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 sh...
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| Format: | Thesis |
| Language: | English |
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Department of Medicine
2021
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| _version_ | 1867613214320099328 |
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| access_status_str | Open Access |
| author | Boloko, Linda |
| author2 | Ntsekhe, Mpiko |
| author_browse | Boloko, Linda Ntsekhe, Mpiko |
| author_facet | Ntsekhe, Mpiko Boloko, Linda |
| author_sort | Boloko, Linda |
| collection | Thesis |
| description | 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. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/32602 |
| institution | University of Cape Town (South Africa) |
| language | eng |
| last_indexed | 2026-06-10T12:32:34.479Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2021 |
| publishDateRange | 2021 |
| publishDateSort | 2021 |
| publisher | Department of Medicine |
| publisherStr | Department of Medicine |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/32602 The impact of HIV on 30-day survival amongst patients undergoing cardiac surgery at Groote Schuur Hospital in the ART era Boloko, Linda Ntsekhe, Mpiko Pennel, Tim Medicine 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. 2021-01-20T13:45:48Z 2021-01-20T13:45:48Z 2020 2021-01-04T12:03:56Z Master Thesis Masters MMed http://hdl.handle.net/11427/32602 eng application/pdf Department of Medicine Faculty of Health Sciences |
| spellingShingle | Medicine Boloko, Linda The impact of HIV on 30-day survival amongst patients undergoing cardiac surgery at Groote Schuur Hospital in the ART era |
| thesis_degree_str | Master's |
| title | The impact of HIV on 30-day survival amongst patients undergoing cardiac surgery at Groote Schuur Hospital in the ART era |
| title_full | The impact of HIV on 30-day survival amongst patients undergoing cardiac surgery at Groote Schuur Hospital in the ART era |
| title_fullStr | The impact of HIV on 30-day survival amongst patients undergoing cardiac surgery at Groote Schuur Hospital in the ART era |
| title_full_unstemmed | The impact of HIV on 30-day survival amongst patients undergoing cardiac surgery at Groote Schuur Hospital in the ART era |
| title_short | The impact of HIV on 30-day survival amongst patients undergoing cardiac surgery at Groote Schuur Hospital in the ART era |
| title_sort | impact of hiv on 30 day survival amongst patients undergoing cardiac surgery at groote schuur hospital in the art era |
| topic | Medicine |
| url | http://hdl.handle.net/11427/32602 |
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