Abstract
Emergency valve replacement for left-sided endocarditis in intravenous drug abusers with a poor long-term prognosis makes the operative decision a difficult one, especially when they are also at risk for HIV infection. The influence of cardiopulmonary bypass on 2 patients may have accelerated the clinical manifes tations of their underlying infections, including a marked acceleration and death in one. These cases suggest that cardiopulmonary bypass perturbs the immune system. The safety of cardiopulmonary bypass in these settings is questioned and a nonoperative approach may be justified in this high-risk group of endocarditis patients.
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