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J Thorac Cardiovasc Surg 2000;120:699-706
© 2000 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

The influence of human T lymphotropic virus type I infection on the outcome of cardiovascular surgery

Hiroshi Masuda, MD, Yukinori Moriyama, MD, Riichiro Toda, MD, Shinji Shimokawa, MD, Yoshifumi Iguro, MD, Shun-ichi Watanabe, MD, Kouichi Hisatomi, MD, Hitoshi Matsumoto, MD, Akira Taira, MD

From the Second Department of Surgery, Kagoshima University Faculty of Medicine, Kagoshima, Japan.

Address for reprints: Hiroshi Masuda, MD, The Second Department of Surgery, Kagoshima University Faculty of Medicine, 8-35-1 Sakuragaoka, Kagoshima 890-8520 Japan (E-mail: masuda{at}med6.kufm.kagoshima-u.ac.jp).

Objective: Human T lymphotropic virus type I infects CD4+ T cells and affects cell-mediated immunity. Cardiopulmonary bypass transiently alters lymphocyte subsets, resulting in a reduction in CD4+ T cells and an increase in CD8+ T cells. We proposed that cardiovascular operations and human T lymphotropic virus type I infection may act synergistically, resulting in serious damage to cell-mediated immunity.
Methods: A total of 517 consecutive patients who were preoperatively screened for anti-human T lymphotropic virus type I antibody and underwent cardiovascular operations with cardiopulmonary bypass were enrolled in this study. Of the 517 patients, 82 (16%) had positive test results for anti-human T lymphotropic virus type I antibody. The surgical outcome of patients with positive and negative results for anti-human T lymphotropic virus type I antibody was analyzed retrospectively.
Results: There was no difference between the 2 groups with respect to early mortality. Distribution of survival curve was also not significantly different (P = .5; mean follow-up duration, 2.4 ± 1.8 years [range, 0-9.4 years] and 3.2 ± 2.8 years [range, 0-9.8 years]) in the groups with positive and negative antibody results, respectively). In particular, long-term follow-up did not reveal adult T-cell leukemia or human T lymphotropic virus type I–associated myelopathy, and occurrence of neoplasm did not differ between groups. Early infectious complication was, however, significantly higher in the group with positive antibody results than in the group with negative results (P = .02). Logistic regression analysis revealed human T lymphotropic virus type I infection as a significant risk for this complication (P = .04; odds ratio, 2.5; 95% confidence interval, 1.0-5.8).
Conclusion: A combination of human T lymphotropic virus type I infection and cardiovascular operation is believed to increase the potential risk of infectious complications shortly after the operation. However, this synergistic effect seems to be transient and has little influence on long-term prognosis.






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