Abstract
Objectives To discuss the dilemma of adequate decision making in patients with intravenous drug
abuse and recurrent valve prosthesis infections or in patients with positive HIV or
hepatitis C status. Ethical, social, and economic considerations, not only in terms
of technical feasibility but also in terms of unpromising results and aspects of resources,
are discussed. Thoughts are presented about the legitimation of cardiac surgery centers
refusing to perform surgery in high-risk patients with HIV or hepatitis C infections.
Methods Presentation of six cases for discussion. Three patients were addicted to intravenous
drugs and had recurrent prosthetic valve endocarditis, and the other three patients
had either paravalvular leakage of a mitral valve prosthesis or acute aortic dissection
or coronary artery disease. Five of these patients suffered from HIV/AIDS and infective
hepatitis C. Four of these patients were refused by other centers due to high risk
or a lack of capacity.
Results All six patients were operated during 2013. Mortality was 17%.
Conclusion Decision making in noncompliant drug addicts with recurrent prosthesis infection
and in HIV-positive patients leads beyond surgical challenges to ethical and economic
considerations.
Keywords
cardiac surgery - addicts - HIV/hepatitis C infection
