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The use of highly active antiretroviral therapy (HAART) in patients with HIV infection has improved survival. This improvement combined with the metabolic effects of treatment has increased cardiovascular risk and the need for cardiac surgery in these patients. We compared morbidity and mortality in HIV-infected patients (cases, n=7) and non-HIV-infected patients (controls, n=21) who underwent isolated coronary artery surgery between 1997 and 2004. The durations of extracorporeal circulation and aortic cross-clamping were shorter in HIV-infected patients (P=.002 and P=.014, respectively). The percentage of patients who experienced complications was similar, at 57.1% in both groups, but there was a slightly higher number of complications per patient in non-HIV-infected individuals. The mean length of total hospitalization was greater in HIV-infected patients (27.1 [13.3] versus 8.8 [5.3] days; P=.003), as was that of postoperative hospitalization (18.2 [15.4] vs 7.9 [4.2] days; P=.08). No HIV-infected patient died or needed a repeat cardiac operation. No progression of the HIV infection was observed. Isolated coronary artery surgery in HIV-infected patients produces good results, and there is no increase in morbidity or mortality. Extracorporeal circulation did not influence disease progression.

Simultaneous vertebral artery and coronary artery bypass are reported in a patient with unstable angina who exhibited signs and symptoms of vertebrobasilar insufficiency while awaiting myocardial revascularization. The indications and various technical options for vertebral artery bypass are reviewed, and the techniques applied in this case are described. Observations on coronary and vertebral vein graft flow, with and without intra-aortic balloon counterpulsation, are presented. Late patency of the aortovertebral vein graft has been documented, and the patient has been free from symptoms of vertebrobasilar and coronary insufficiency for 5 years.