Introduction

The landscape of Human I mmunodeficiency Virus (HIV) is now treatment has undergone profound transformation since the 1980s. The advent of Antiretroviral Therapy (ART), coupled with advancements in HIV diagnosis and management, has substantially enhanced the prognosis for individuals living with HIV, leading to near-normal lifespans despite the presence of a chronic disease. Notably, patients receiving ART experience life expectancies following HIV diagnosis that are 5 to 7 times longer compared to those without access to such treatment. However, as adherence to ART has improved, there has been a growing awareness of the impact of HIV and its treatment of cardiovascular health. Research indicates that individuals with HIV face a twofold increased risk of cardiovascular disease compared to their HIV-negative counterparts. This elevated risk is attributed, in part, to the adverse effects of ART medications, which include dyslipidemia, reduced insulin sensitivity, and body fat redistribution, all of which contribute to cardiovascular risk. Recent studies, such as one published in JAMA, have highlighted the heightened susceptibility of HIV-positive individuals to conditions like myocardial infarction, stroke, heart failure, peripheral vascular disease, atrial fibrillation, and cardiovascularrelated hospitalizations. As individuals with HIV are now living longer, they are increasingly presenting with a spectrum of cardiovascular issues that necessitate comprehensive cardiac interventions, including coronary bypass, heart valve repair/ replacement, and even heart transplantation. However, despite advancements in surgical techniques and risk assessment tools, there remains a gap in accurately assessing the perioperative risks of cardiac surgery in HIV-positive patients. Existing riskscoring systems, such as the European System for Cardiac Operative Risk Evaluation and the Society of Thoracic Surgeons (STS) Predicted Risk of Mortality score, do not explicitly identify HIV infection as a perioperative risk factor. HIV-positive patients are often categorized as "immunocompromised" without specific consideration of their unique cardiac surgical risks. Furthermore, there is a notable dearth of data regarding the outcomes of cardiac surgery in HIV-positive individuals, particularly among those effectively managed on ART therapy with undetectable viral loads. As such, there is an urgent need for further research to address these gaps in knowledge and refine risk assessment strategies to ensure optimal cardiac care for individuals living with HIV.

Ventilation requirements

Acute respiratory failure remains a significant concern for patients following cardiac surgery, contributing substantially to both morbidity and mortality rates. Extended reliance on mechanical ventilation exacerbates clinical challenges, leading to adverse outcomes. Tracheostomy, a procedure commonly performed in critically ill ventilated patients, offers several benefits including reduced ventilation duration, shorter stays in the Intensive Care Unit (ICU), decreased mortality rates, and enhanced patient comfort with fewer sedatives. Despite mounting evidence advocating for early tracheostomy in cardiac surgery patients, limited research exists regarding its impact on hemodynamic stability post-surgery. The administration of high doses of inotropic and vasoactive medications in cardiac surgery patients is associated with unfavorable prognoses. Recent investigations in both pediatric and adult cardiac surgery cohorts have introduced the Vasoactive-Inotrope Score (VIS) as a standardized metric to quantify the extent of vasoactive and inotropic support required, serving as a predictive tool. VIS calculates a weighted sum of all administered inotropes and vasopressors and has been validated for use in cardiac surgery settings. Our observations suggest that cardiac surgery patients with prolonged ventilation requirements experience improved hemodynamic stability following tracheostomy placement. We aimed to explore the potential influence of tracheostomy on VIS score and hemodynamic equilibrium in this patient population. Our hypothesis posited that a visual representation of VIS trends before and after tracheostomy would reveal a distinct inflection point, indicating a measurable effect of tracheostomy on hemodynamic stability. Through this investigation, we sought to quantify any observed changes in VIS scores pre- and posttracheostomy, shedding light on the impact of tracheostomy placement on the hemodynamic profile of patients undergoing cardiac surgery. The landscape of Human Immunodeficiency Virus (HIV) treatment has undergone significant transformation since the 1985s. Advancements in the diagnosis and management of HIV, coupled with the widespread adherence to Anti-Retroviral Therapy (ART), have revolutionized the prognosis for HIV-positive individuals, transitioning the condition from a once-debilitating illness to a manageable chronic disease.

Medicare databases

This shift has resulted in HIV-positive patients now experiencing lifespans akin to those of individuals without the virus, with life expectancy following diagnosis increasing by 5 to 7 times among those effectively managed with ART. Yet, alongside these remarkable strides in HIV care, a heightened awareness has emerged regarding the interplay between the virus, its treatment, and the development of cardiovascular disease. HIVpositive individuals face a twofold increased risk of cardiovascular disease compared to their HIV-negative counterparts, partly attributable to the effects of ART medications. These medications can induce dyslipidemia, diminish insulin sensitivity, and lead to body fat redistribution, collectively augmenting the risk of cardiovascular complications. Recent research, such as a study published in JAMA utilizing data from the market scan Commercial and medicare databases, has underscored the elevated cardiovascular risks faced by HIV-positive patients. This study revealed a heightened susceptibility to myocardial infarction, stroke, heart failure, peripheral vascular disease, atrial fibrillation, and various cardiovascular-related hospitalizations among HIV-positive individuals. Moreover, the prolonged lifespan of HIV-positive patients has necessitated the provision of a comprehensive spectrum of cardiac interventions, including coronary bypass surgery, heart valve repair/replacement, and even heart transplantation. However, despite these advancements, there remains a notable gap in accurately assessing the risks associated with HIV infection in the context of cardiac surgery. In essence, while significant progress has been made in extending and enhancing the lives of HIV-positive individuals through ART and improved management strategies, the evolving understanding of HIV's impact on cardiovascular health underscores the need for continued vigilance and targeted interventions to mitigate associated risks and optimize patient outcomes, particularly in the realm of cardiac care.