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"Kejadian Systemic Inflammatory Response Syndrome (SIRS) pasca bedah jantung terbuka masih merupakan salah satu komplikasi yang banyak ditemukan. Salah satu faktor risikonya adalah durasi pintas jantung. Studi kohort retrospektif dilakukan terhadap 187 pasien bedah jantung terbuka di RSUPN Cipto Mangunkusumo tahun 2014-2015. Subjek dibedakan menjadi 2 kelompok berdasarkan durasi pintas jantung (durasi >60 menit dan ≤60 menit). Sebanyak 107 (57,2%) pasien mengalami SIRS dalam 24 jam pasca operasi. Kejadian SIRS ditemukan pada 75 (65,8%) pasien dari kelompok durasi >60 menit dan 32 (43,8%) pasien dari kelompok durasi ≤60 menit. Melalui analisis multivariat regresi logistik, didapatkan hubungan bermakna (p<0,05) antara durasi CPB dan SIRS dengan OR2,04 (IK95% 1,05-3,93). Durasi CPB merupakan faktor risiko independen dari kejadian SIRS pasca bedah jantung terbuka.

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Sytemic inflammatory Response Syndrome (SIRS) is a major complication foundat patient following open heart surgery. One of the risk factors is the duration of the cardiopulmonary bypass. A historical cohort study had been done on 187 postcardiac surgery patients in RSUPN Cipto Mangunkusumo. The subjects were divided into 2 separate groups based on the duration of cardiopulmonary bypass (duration >60 minutes and ≤60 minutes). There were 107 (57.2%) patients having SIRS within 24 hours following the surgery. SIRS was found on 75 (65.8%) patients from group with duration >60 minutes and 32 (43.8%) patients from group with duration ≤60 minutes. Through logistic regression multivariate analysis, there was a significant difference (p<0.05) with OR 2.04 (CI95% 1.05-3.93) between two groups. Therefore, duration of cardiopulmonary bypass was an independent risk factor of post open heart surgery SIRS."

"Latar Belakang: Penyakit jantung bawaan (PJB) dikoreksi dengan bedah jantung terbuka dengan bantuan alat mesin pintas jantung paru (cardiopulmonary bypass). Namun teknik ini dapat menyebabkan inflamasi pada paru yang menghasilkan kondisi Acute Respiration Dysfunction Syndrome (ARDS). Meskipun insidensinya pada pasien bedah dengan mesin pintas jantung paru hanya rendah, tingkat mortalitasnya dapat mencapai 50%. Tujuan: Mengetahui hubungan antara durasi penggunaan mesin jantung paru dengan insidensi ARDS pada pasien anak dengan PJB pasca bedah jantung terbuka. Metode: Studi kohort retrospektif dilakukan terhadap 194 anak yang menjalani bedah jantung terbuka atas indikasi PJB di Unit Pelayanan Jantung Terpadu (UPJT) RSCM periode Januari 2014-September 2015. Hasil: 64 (32,99%) pasien mengalami ARDS pasca bedah jantung terbuka dan sisanya sebanyak 130 (67,01%) tidak mengalami ARDS. Median penggunaan mesin pada golongan ARDS dan non-ARDS masing-masing sebesar 80 menit (23-219, IK90%) dan 70 menit (18-320, IK90%). Insidensi ARDS pada kelompok dengan durasi pendek (≤60 menit) adalah 27,5% dan dengan durasi panjang (> 60 menit) adalah 36%. Secara statistik dan klinis tidak terdapat hubungan bermakna antara durasi penggunaan mesin dengan munculnya ARDS (p = 0,298, uji chi square). Kesimpulan: Tidak terdapat hubungan bermakna antara durasi penggunaan mesin pintas jantung paru dengan kejadian ARDS pada pasien PJB pasca bedah jantung terbuka.

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Background: Congenital heart disease (CHD) is corrected by open thoracic surgery with the help of cardiopulmonary bypass machine (CPB). This technique can cause pulmonary inflammation resulting in Acute Respiratory Distress Syndrome (ARDS). Even though its incidence is low, the mortality rate of is up to 50%.

Aim: To find whether the duration of CPB using is related with incidence of ARDS in pediatric patients underwent open thoracic surgery.

Methods: Retrospective cohort study was done involving 194 pediatric patients underwent open thoracic surgery with CHD indication at Unit Pelayanan Jantung Terpadu (UPJT) RSCM within January 2014 and 2015 September.

Results: 64 (32,99%) patients had ARSD after open thoracic surgery. The mean of CPB machine duration was 80 minutes (23-219, CI90%) in patients with ARDS and 70 minutes (18-320, CI90%) in patients with no ARDS. The incidence of ARDS in patients with short duration of CPB (≤60 minutes) was 27.5% and long duration (>60 minutes) was 36%. There was no such correlation statistically and clinically between duration of CPB and ARDS occurence (p = 0.298, chi square test).

Conclusion: Duration of CPB using is not related with ARDS occurrence in pediatric patients with CHD underwent open thoracic surgery."

"Acute Kidney Injury (AKI) pada anak dengan penyakit jantung bawaan mencakup 5-33% dari seluruh pasien anak yang melalui bedah jantung terbuka, dengan dampak yang signifikan terhadap kualitas hidup dan luaran pasien. Salah satu faktor yang mempengaruhi kejadian AKI adalah durasi penggunaan mesin pintas jantung paru. Penelitian metode kohort retrospektif dilakukan terhadap 122 pasien dengan durasi panjang dan 73 pasien dengan durasi pendek pasca bedah jantung terbuka di PJT RSUPN Cipto Mangunkusumo. Data rekam medis yang dianalisis menunjukkan bahwa terdapat kemaknaan (p<0,05) hubungan antara durasi CPB dengan AKI dengan OR 2,95. Kesimpulan penelitian adalah durasi CPB >60 menit merupakan faktor risiko terjadinya AKI pasca bedah jantung terbuka.

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Acute kidney injury (AKI) in children with congenital heart disease consists of 5-33% pediatric patients who went through open heart injury, with significant impact on the quality of life and outcome of the patient. One of the factors affecting the incidence of AKI is the duration of cardiopulmonary bypass machine. Retrospective cohort study was done on 122 patients with bypass duration >60 minute and 73 patients with bypass duration <60 minute after open heart surgery in PJT RSUPN Cipto Mangunkusumo. Analysis of medical records shown that there was a significant difference (p<0,05) between the duration of cardiopulmonary bypass with the incidence of AKI with OR of 2,95. It was concluded that duration of bypass >60 minutes was a risk factor of post open heart surgery AKI."

"Latar belakang: Operasi jantung terbuka dengan menggunakan mesin bypass kardiopulmoner (CPB) berpotensi menimbulkan respons inflamasi yang signifikan. Salah satu penyebab respons inflamasi ini adalah kontak darah dengan sirkuit ekstrakorporeal dan shear stress non-fisiologis selama operasi pompa CPB. Penelitian ini bertujuan untuk menentukan teknik mana yang menghasilkan respons sindrom inflamasi sistemik (SIRS) yang lebih ringan.Metode: Penelitian kohort retrospektif. Pengambilan data dilakukan di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita (RSJPDHK) sejak Juli 2018 hingga Februari 2023. Subjek yang direkrut secara konsekutif adalah pasien dengan diagnosis penyakit jantung koroner yang menjalani operasi bedah pintas arteri koroner, baik dengan menggunakan teknik CCABG atau dengan teknik OPCAB. Setelahnya subjek dilakukan pemeriksaan IL-6 pada 6 jam pasca operasi, CRP dan PCT pada 6, 24, dan 48 jam pascaoperasi. Setelahnya, pasien dinilai keluaran SIRS dan mortalitasnya.Hasil: Total subjek penelitian ada 70 subjek, dengan perbandingan laki-laki yang menjalani OPCAB (82,9%) dan CCABG (91,4%), sisanya berjenis kelamin perempuan. Terdapat perbedaan bermakna antara SIRS dengan jenis operasi (p = 0,048). Kadar IL-6 pada 6 jam pascaoperasi menunjukkan hasil berbeda bermakna dengan jenis operasi (0,014). Pada 24 jam pascaoperasi, penanda inflamasi menunjukkan hasil berbeda bermakna pada CRP (p = 0,013) dan PCT (0,001). Sedangkan pada 48 jam pascaoperasi juga menunjukkan hasil berbeda bermakna pada CRP (p = 0,002) dan PCT (p = 0,022). Peningkatan angka kejadian aritmia pada CCABG menunjukkan perbedaan bermakna juga dengan nilai p <0,001 (IK95% 6,14(1,63-23,16)).

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Background: Open heart surgery using a cardiopulmonary bypass (CPB) machine has the potential to induce a significant inflammatory response. One of the causes of this inflammatory response is blood contact with the extracorporeal circuit and non-physiological shear stress during CPB pump operation. This study aims to determine which technique yields a milder systemic inflammatory response syndrome (SIRS) outcome.

Method: This is a retrospective cohort study. Data collection was conducted at Harapan Kita Heart and Blood Vessel Hospital (RSJPDHK) from July 2018 to February 2023. Consecutively recruited subjects were patients diagnosed with coronary heart disease who underwent coronary artery bypass grafting (CABG) surgery, either using the conventional technique (CCABG) or off-pump technique (OPCAB). Subsequently, IL-6 levels were examined at 6 hours post-surgery, while CRP and PCT levels were measured at 6, 24, and 48 hours post-surgery. Following these assessments, patients were evaluated for the occurrence of systemic inflammatory response syndrome (SIRS) and mortality.

Result: There were a total of 70 subjects, with a comparison of males who underwent OPCAB (82.9%) and CCABG (91.4%), the rest were female. There was a significant difference between SIRS and the type of surgery (p = 0.048). IL-6 levels at 6 hours postoperatively showed significantly different results with the type of surgery (0.014). At 24 hours postoperatively, inflammatory markers showed significantly different results for CRP (p = 0.013) and PCT (0.001). Whereas at 48 hours postoperatively it also showed significantly different results on CRP (p = 0.002) and PCT (p = 0.022). The increase in the incidence of arrhythmias in CCABG also showed a significant difference with a value of p <0.001 (95%CI 6.14 (1.63-23.16)).

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"Latar belakang: Penurunan curah jantung merupakan masalah yang penting dalam penatalaksanaan pasca-bedah jantung terbuka karena penurunan curah jantung ini meningkatkan morbiditas dan mortalitas pasien. Modalitas untuk pemantauan curah jantung bergeser dari invasif ke non-invasif. Alat ultrasonic cardiac output monitor (USCOM) dan ekokardiografi menjadi alat baru yang non-invasif. Bila dibandingkan dengan alat ekokardiografi yang membutuhkan keahlian khusus, alat USCOM dapat dijadikan alat pengukuran indeks curah jantung alternatif secara intermiten oleh tenaga medis terlatih.Tujuan: Untuk mengetahui kesesuaian hasil pengukuran indeks curah jantung dengan alat USCOM dibandingkan ekokardiografi pada anak pasca-bedah jantung terbuka dengan pintasan jantung paru.Metode: Studi potong lintang (cross sectional) pada anak pasca-bedah jantung terbuka dengan PJP dengan metode pengukuran simultan indeks curah jantung dengan alat USCOM dan ekokardiografi di Rumah Sakit Cipto Mangunkusumo, Jakarta, dari bulan Juni-Juli 2014.Hasil: Tiga belas pasien yang menjalani bedah jantung terbuka berhasil diukur dengan alat USCOM dan ekokardiografi secara simultan. Subyek terdiri atas 8 laki-laki dan 5 perempuan dengan median usia 3 tahun (1-12 tahun). Median berat badan, tinggi badan, dan luas permukaan tubuh berturut-turut 11 kg (5,5-29 kg), 82 cm (63-133 cm), dan 0,53 m2 (0,32- 0,98 m2). Diagnosis terbanyak berturut-turut adalah tetralogi Fallot (5 subyek), defek septum ventrikel (3 subyek), dan DORV (2 subyek). Pada analisis Bland-Altman indeks curah jantung yang diukur dengan alat USCOM dibandingkan ekokardiografi didapatkan perbedaan rerata sebesar 0,115 L/menit/m2 (IK95% -0,536 hingga 0,766) dan batas kesesuaian -3,616 hingga 3,846 L/menit/m2. Hasil tambahan penelitian ini berupa perbedaan rerata indeks isi sekuncup 0,03 mL/m2 (IK95% -5,002 hingga 5,065) dan batas kesesuaian -28,822 hingga 28,885 mL/m2. Perbedaan rerata diameter LVOT -0,017 cm (IK95% -0,098 hingga 0,064) dan batas kesesuaian -0,285 hingga 0,251 cm. Perbedaan rerata nilai VTI didapatkan sebesar -2,991 cm (IK95% -4,670 hingga -1,311) dan batas kesesuaian -12,616 hingga 6,635 cm.Kesimpulan: Pengukuran indeks curah jantung dengan alat USCOM dibandingkan ekokardiografi pada anak pasca-bedah jantung terbuka dengan PJP didapatkan perbedaan rerata kedua pengukuran kecil dan batas kesesuaian 95% yang lebar. Pada pengukuran indeks curah jantung yang makin rendah, perbedaan atau selisih rerata semakin kecil dan memiliki kesesuaiannya lebih baik.

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Background: Low cardiac output is important problem in post-open heart surgery management because this condition increase morbidity and mortality. Modality of cardiac output monitoring shifted from invasive to non-invasive. Ultrasonic cardiac output monitor (USCOM) and echocardiography are new non-invasive tools. Echocardiography needs special skill, but USCOM can used by trained user because of fast learning curve of skill.Objectives: To determine the agreement of cardiac index measurement by USCOM and echocardiography in children after open heart surgery with cardiopulmonary bypass.Methods: Cross sectional study using simultaneous measurement of cardiac index by USCOM and echocardiography on post-open heart surgery patient in Cipto Mangunkusumo Hospital Jakarta, from Juni-Juli 2014.Results: Thirteen post-open heart surgery of pediatric patient were enrolled (8 male and 5 female, median of age 3 years old (1-12 years old). Median of body weight, height, and body surface area respectively were 11 kg (5,5-29 kg), 82 cm (63-133 cm), dan 0,53 m2 (0,32-0,98 m2). Diagnosis of patient were tetralogi Fallot (5 subject), ventricular septal defect (3 subject), dan double outlet right ventricle (2 subject). This study using Bland-Altman analysis of cardiac index measurement by USCOM and echocardiography. Mean bias was 0,115 L/minute/m2 (95%CI -0,536 to 0,766) and limit of agreement was -3,616 to 3,846 L/minute/m2. Secondary outcome of this study was mean bias of stroke volume index 0,03 mL/m2 (95%CI -5,002 to 5,065) and limit of agreement was -28,822 to 28,885 mL/m2. Mean bias of LVOT diameter was -0,017 cm (95%CI -0,098 to 0,064) and limit of agreement was -0,285 to 0,251 cm. Mean bias of VTI was -2,991 cm (95%CI -4,670 to -1,311) and limit of agreement -12,616 to 6,635 cm.Conclusion: Cardiac index measurement by USCOM and echocardiography in children after open heart surgery has narrow mean bias and wide limit of agreement. Mean bias was narrower and good agreement in patient with low cardiac index."

"Latar Belakang: Pasien dengan fraksi ejeksi (FE) rendah memiliki risiko apabila dilakukan BPAK dengan mesin PJP. Pengunaan mesin PJP memiliki risiko cedera miokard yang diakibatkan dari periode iskemia, reperfusi, dan inflamasi yang dapat mengakibatkan aritmia pascaoperasi. Aritmia pascaoperasi BPAK terjadi pada 5-40% dan meningkatkan mortalitas serta morbiditas. Glutamin merupakan asam amino yang memiliki efek anti inflamasi dengan menurunkan mediator inflamasi dan kerusakan oksidatif akibat radikal bebas sehingga menurunkan efek cedera miokard dan dihipotesiskan menurunkan kejadian aritmia pascaoperasi BPAK. Metodologi: Penelitian ini kohort retrospektif pada pasien penyakit jantung koroner dengan FE rendah yang menjalani BPAK menggunakan mesin PJP. Subjek dibagi menjadi kelompok yang mendapat dan tidak mendapat glutamin intravena praoperasi. Luaran yang dinilai adalah kejadian aritmia pascaoperasi secara keseluruhan, arimita ventrikel dan supraventrikel pascaoperasi BPAK. Hasil: Kejadian aritmia pascaoperasi lebh rendah secara bermakna pada kelompok yang mendapatkan glutamin intravena praoperasi, yaitu 16,7%dibandingkan 40% (p=0,045). Kejadian aritmia atrium pascaoperasi juga lebih rendah secara bermakna pada kelompok yang mendapat glutamin intravena praoperasi, yaitu 26,7% dibandingkan 73,3% (p=0,026), namun pada kejadian aritmia ventrikel pascaoperasi tidak ada perbedaan bermakna (p=0,74). Kesimpulan: Pada pasien dengan fraksi ejeksi rendah yang menjalani BPAK menggunakan mesin PJP, pemberian glutamin intravena praoperasi dapat menurunkan angka kejadian aritmia pascaoperasi.

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Background: Low ejection fraction (EF) increases the risk of morbidity and mortality in patients undergoing CABG. CABG with CPB induces myocardial injury caused from ischemia, reperfusion and inflammation, causing postoperative arrhythmias. Arrhyhtmias occur in 5-40% patients after CABG and increase postoperative mortality and morbidity. Glutamine is an amino acid that has antiinflammatory effect, decerasing inflammatory mediators and oxidative stress from free radicals. In turn, glutamin lower the effect of myocardial injury and hypothesized to lower postoperative arrhythmias after CABG.

Methods: This is a cohort retrospective study in patients with coronary artery disease with low EF undergoing CABG with CPB. The subjects were divided into two groups based on given or not given intravenous glutamin preoperative.The outcomes of the study is incidence of arrhythmias after CABG and the incidence of ventricular and supraventricular arrhythmias after CABG.

Results: The subjects in the intravenous glutamin group have lower incidence of postoperative arrhythmias compared to control (16.7% vs 40% respectively, p=0.045). Supraventricular arrhythmia incidence in intravenous glutamin group is also lower compard to control (26.7% vs 73.3% respectively, p=0,026). There are no significant differences of postoperative ventricular arrhythmias between two groups (p=0.74).

Conclussion: In patients with low EF undergoing CABG with CPB, intravenous glutamin administration can lower the incidence of postoperative arrhythmias."

"Latar Belakang: Salah satu tata laksana revaskularisasi pada Penyakit jantung koroner (PJK) adalah bedah pintas arteri koroner (BPAK). Salah satu teknik BPAK menggunakan mesin pintas jantung paru (PJP) yang dapat menyebabkan reaksi inflamasi sehingga terjadi penurunan tahanan vaskular sistemik (TVS) sehingga meningkatkan mortalitas dan morbiditas. Glutamin adalah asam amino non esensial yang dapat menjadi esensial kondisional pada keadaan kritis dan memiliki peran membantu regulasi tonus endotel. Metodologi: Penelitian ini merupakan studi observasional analitik dengan desain penelitian kohort retrospektif. Sampel dipilih secara metode consecutive sampling dan metode randomisasi blok. Variabel-variabel yang diperiksa dilakukan uji normalitas. Variabel dengan sebaran normal dilakukan analisis statistik independent t-test, sedangkan variabel dengan sebaran tidak normal dilakukan analisis statistik Mann-Whitney test. Hasil: Berdasarkan hasil penelitian dapat disimpulkan bahwa pemberian glutamin preoperasi pada pasien penyakit jantung koroner dengan FE rendah yang menjalani BPAK mengalami penurunan TVS pada jam keenam pascaoperasi (p = 0,04) namun mengalami peningkatan curah jantung pada jam keenam (p = 0,015). Hasil pada jam ke-24 TVS pascaoperasi juga mengalami penurunan namun terlihat signifikan bila melihat faktor perancu -844,9+27,8 (ejeksi fraksi praoperasi)+0,4 (Kadar Glutamin Praoperasi)+14 (Umur) Adjusted R square = 21,9%. Curah jantung jam ke-24 pascaoperasi mengalami peningkatan secara signifikan tanpa melihat variabel perancu (p = 0,037) maupun dengan melihat variabel perancu umur (p = 0,003) dan FE praoprasi (p = 0,006) (adjusted r quare = 23,6%). Kesimpulan: Pada pasien dengan fraksi ejeksi rendah yang menjalani BPAK menggunakan mesin PJP, pemberian glutamin intravena praoperasi menyebabkan penurunan TVS disertai dengan peningkatan curah jantung pada pemantauan jam keenam dan jam ke-24.

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Background: Coronary Artery Bypass Graft (CABG) is one of revascularization treatment in coronary artery disease patient. The most common CABG technique uses a cardiopulmonary bypass (CPB) machine which can cause an inflammatory reaction resulting in a decrease in systemic vascular resistance (SVR) thereby increasing mortality and morbidity. Glutamine is a non-essential amino acid that can become conditionally essential in critical situations such as systemic inflammatory respose syndrome (SIRS) and has a role in assisting the regulation of endothelial tone.

Methods: This study is an analytic observational study with a retrospective cohort study design. Samples were selected by consecutive sampling method and block randomization method. The variables examined were tested for normality. Variables with normal distribution were analyzed statistically by independent t-test, while variables with abnormal distribution were analyzed by Mann-Whitney test. Each confounding variables then put together and analyzed statistically with multivariate approach.

Results: Based on the results of the study, it can be concluded that preoperative administration of glutamine in patients with coronary heart disease with low ejection fraction (EF) who underwent CABG experienced a decrease in SVR at the sixth postoperative hour (p = 0.04) but increased cardiac output at the sixth hour (p = 0.015). The results at 24 hours postoperative also shows decreased SVR but were significant when looking at its confounding factors for preoperative EF (p = 0.001), preoperative glutamine levels (p = 0.01), and age (p = 0.013) (adjusted r square = 21.9%). Cardiac output at 24 hours postoperatively increased significantly regardless of confounding variables (p = 0.037) or by looking at its confounding factor; age (p = 0.003) and preoperative EF (p = 0.006) (adjusted r square = 23.6%).

Conclussion: In patients with low EF undergoing CABG with CPB, intravenous glutamin administration can decrease SVR and increase cardiac output in 6 hours and 24 hours observation."

"Latar belakang : Pasien penyakit jantung bawaan memiliki risiko untuk mengalamikehilangan berbagai macam mikronutrien sesudah operasi koreksi dengan mesin pintasjantung paru, salah satunya adalah vitamin D. Defisiensi vitamin D dapat memperberatkomplikasi yang terjadi sesudah operasi koreksi dengan mesin pintas jantung paru.Penelitian ini bertujuan untuk menilai efek dari mesin pintas jantung paru terhadapkadar vitamin D sesudah operasi koreksi penyakit jantung bawaan.Metode : Penelitian dilakukan secara kohort prospektif dari bulan Maret-Juli 2020.Pada penelitian ini didapatkan total 30 pasien yang menjalani operasi koreksi denganmesin pintas jantung paru. Pemeriksaan kadar vitamin D dilakukan sebelum operasi dan24 jam sesudah mesin pintas jantung paru dimatikan.Hasil : Rerata kadar vitamin D preoperasi adalah 27,24 ng/mL dengan yang mengalamiinsufisiensi dan defisiensi sebanyak 70%. Rerata kadar vitamin D sesudah operasiadalah 20,73 ng/mL dengan jumlah subjek yang mengalami insufisensi dan defisiensimeningkat sebanyak 90%. Setelah operasi, terdapat penurunan vitamin D sebanyak 6,52ng/mL (24% dari kadar sebelum operasi). Uji korelasi antara penurunan kadar vitaminD dengan penggunaan mesin PJP menunjukkan hasil yang signifikan dengan nilai P <0,001. Sedangkan tidak ditemukan hubungan yang signifikan antara durasi penggunaanmesin pintas jantung paru dan durasi aortic cross clamp dengan penurunan kadarvitamin D.Kesimpulan : Terdapat hubungan yang bermakna antara penggunaan mesin pintasjantung paru dengan penurunan kadar vitamin D, namun penurunan ini tidakdipengaruhi oleh durasi penggunaan mesin pintas jantung paru dan durasi aortic crossclamp.

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Background: Patients with congenital heart disease are at risk of losing various

micronutrients after corrective surgery with a cardio-pulmonary bypass machine, one

of which is vitamin D. Vitamin D deficiency can exacerbate complications that occur

after corrective surgery with a cardio-pulmonary bypass machine. This study aimed to

assess the effect of the cardio-pulmonary bypass machine on vitamin D levels after

corrective surgery for congenital heart disease.

Methods: This study was conducted in a prospective cohort from March to July 2020.

In this study, a total of 30 patients underwent corrective surgery with cardio-pulmonary

bypass machine. Vitamin D level checks were carried out before surgery and 24 hours

after the machine was turned off.

Results: The mean preoperative vitamin D level was 27.24 ng / mL with insufficiency

and deficiency as much as 70%. The mean postoperative vitamin D level was 20.73

ng/mL with the number of subjects experiencing insufficiency and deficiency increasing

by 90%. After surgery, there was a decrease in vitamin D by 6.52 mg / mL (24% of the

preoperative level). The correlation test between decreased levels of vitamin D and the

use of cardio-pulmonary bypass machines showed significant results with a P-value

<0.001. Meanwhile, there was no significant relationship between the duration of using

the cardio-pulmonary bypass machine and the duration of aortic cross clamp with a

decrease in vitamin D

Conclusion: There is a significant relationship between the use of cardio-pulmonary

bypass machines and a decrease in vitamin D levels, but this decrease was not

influenced by the duration of using the cardio-pulmonary bypass machine and the

duration of the aortic cross clamp."

"Penyakit jantung koroner (PJK) menyebabkan ketidakseimbangan suplai dan kebutuhan metabolik miokard dalam melakukan fungsi sirkulasi dan homeostasis. Baku emas terapi PJK adalah bedah pintas arteri koroner (BPAK). Prosedur BPAK dengan mesin pintas jantung paru (PJP) dapat mencetuskan cedera miokard tingkat selular sehingga memerlukan aplikasi proteksi miokard. Glutamin adalah asam amino conditionally essential yang berperan dalam proteksi miokard dengan membentuk energi selama periode iskemia, tetapi belum teruji penggunaannya pada pasien dengan fraksi ejeksi rendah. Padahal, pasien fraksi ejeksi (EF) rendah lebih rentan terhadap cedera miokard, sehingga glutamin diharapkan dapat memberi proteksi. Penelitian menggunakan desain double blind randomized controlled trial di Instalasi Bedah Jantung Dewasa RSJPDHK Jakarta pada bulan Januari–Agustus 2021 dengan subjek penelitian 60 pasien sesuai kriteria inklusi dan eksklusi. Alokasi random subjek untuk memilih 30 pasien mendapatkan 500 mL glutamin 0,5 g/kg dalam NaCl 0,9% sebagai kelompok intervensi (glutamin), dan 30 pasien mendapatkan NaCl 0,9% sebanyak 500 mL sebagai kelompok kontrol selama 24 jam pertama. Pengukuran yang dilakukan meliputi kadar glutamin plasma, kadar α-KG, myocardial injury score, indeks apoptosis, ekspresi anti-kardiak troponin I, kadar troponin I, EF, indeks jantung dan kadar laktat. Dua subjek drop out sehingga analisis dilakukan terhadap 58 subjek. Efek proteksi miokard glutamin terlihat pada kadar troponin I, laktat plasma, dan myocardical injury score yang lebih rendah pada kelompok glutamin, serta ekspresi anti-kardiak troponin I jaringan apendiks atrium kanan jantung setelah mesin PJP dilepas lebih tinggi dibandingkan kontrol. Tidak didapatkan perbedaan bermakna indeks apoptosis jaringan apendiks atrium kanan, fraksi ejeksi pasca-operasi, penggunaan vasoaktif dan inotropik pasca-operasi, durasi penggunaan ventilator dan durasi perawatan intensif pasca-operasi pada kedua kelompok. Simpulan: Pemberian preoperatif glutamin 0,5 g/kg secara intravena dalam 24 jam pertama memiliki efek proteksi miokard pada pasien BPAK elektif dengan EF rendah yang menggunakan mesin PJP.

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Coronary heart disease (CHD) causes a myocardial metabolic supply and demand imbalance in performing circulatory and homeostatic functions. The gold standard treatment of CHD is coronary artery bypass graft (CABG). The CABG procedure with a cardiopulmonary bypass (CPB) machine can trigger myocardial injury at cellular level due to ischemia and reperfusion. Glutamine is a conditionally essential amino acid in the human body which has a role as myocardial protector through energy production during myocardial ischemia. However, its application has not been tested in low ejection fraction (EF) patients. Meanwhile, patients with low EF are more vulnerable to myocardial injury. Thus, glutamine administration was expected to provide myocardial protection. The study was a double-blind, randomized controlled trial design and was performed at the Adult Cardiac Surgery Installation of the National Cardiovascular Center Harapan Kita, Jakarta from January to August 2021 with a sample size of 60 patients meeting the inclusion and exclusion criteria. Subjects were randomly allocated into intervention (glutamine): 30 patients were administered a solution of glutamine 0.5 g/kg dissolved in 0.9% NaCl up to 500 mL in total volume and control group; 30 patients were administered 500 mL of 0.9% NaCl, both over a period of the first 24 hours. Parameters measured include plasma glutamine levels, α-KG levels, myocardial injury scores, apoptotic index, anti-cardiac troponin I expression, troponin I levels, EF, cardiac index and lactate levels. Two samples were dropped out; hence 58 patients were analyzed in this study. Myocardial protective effects of glutamine are observed in plasma troponin I, lactate levels, and myocardial injury score of right atrial appendage tissue, which were significantly lower in the glutamine group and higher anti-cardiac troponin I expression of right atrial appendage tissue in the glutamine group. Apoptotic index of right atrial appendage tissue, postoperative ejection fraction, postoperative use of vasoactive and inotropic, ventilator time, and duration of intensive care showed no significant differences in both groups. Conclusion: Preoperative administration of intravenous glutamine 0.5 g/kg in the first 24 hours has a cardioprotective effect in low EF patients underwent elective on-pump CABG."

"[ABSTRAKLatar Belakang: Pada anak dengan penyakit jantung bawaan (PJB) yangmenjalani operasi jantung terbuka, sepsis merupakan salah satu komplikasipascaoperasi. Lama prosedur pintas jantung paru, usia, status gizi, timektomi, danvariasi genetik, seperti polimorfisme toll-like receptor (TLR) 2 dan tollinteractingprotein (TOLLIP) dapat memengaruhi respons imun. Informasimengenai peran faktor tersebut terhadap kejadian sepsis dan respons imunpascaoperasi jantung terbuka masih terbatas.Tujuan: Mengetahui peran polimorfisme TLR2, TOLLIP, dan faktor lainnyaterhadap kejadian sepsis dan respons imun pascaoperasi jantung terbuka untukmemperoleh strategi paling tepat dalam penanganan kasus bedah jantung padaanak.Metodologi: Studi longitudinal dengan non-probability consecutive samplingdilakukan pada anak <1 tahun yang menjalani operasi jantung terbuka.Pemeriksaan polimorfisme TLR2 Arg677Trp, TLR2 N199N, TOLLIP rs5743867,sel CD4 dan CD8 yang menyekresikan IFN-γ intraselular, sel Dendritik yangmengekspresikan TLR2, dan sel NK. Pasien menjalani operasi jantung terbuka.Setelah operasi, pasien dimonitor untuk menilai sepsis dan respons imunpascaoperasi.Hasil: Dari 108 subjek yang terlibat, 21,3% diantaranya mengalami sepsis.Seluruh subjek adalah mutan TLR2 Arg677Trp, 92,6% pasien adalah mutan TLR2N199N, dan 52,8% pasien adalah mutan TOLLIP rs5743867. Polimorfisme TLR2N199N dan timektomi total tidak diikutkan dalam model analisis multivariat.Polimorfisme TOLLIP rs5743867 (p = 0,358) menurunkan resiko sepsis, lamaprosedur pintas jantung paru ≥90 menit (p = 0,002), usia neonatus (p = 0,032), dangizi buruk (p = 0,558) meningkatkan risiko sepsis pascaoperasi. Jumlah responsimun bervariasi antara kategori, namun secara umum komponen respons imunlebih rendah pada pasien yang mengalami sepsis dibanding pada pasien yang tidakmengalami sepsis.Simpulan: Lama prosedur pintas jantung paru dan usia neonatus secara signifikanmemengaruhi risiko dan kecepatan sepsis pascaoperasi. Peran polimorfisme TLR2N199N dan TOLLIP rs5743867 terhadap kejadian sepsis dan respons imunpascaoperasi memerlukan studi komprehensif lebih lanjut.

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ABSTRACTBackground: Sepsis is one of the complications in children with congenital heartdefect who underwent open heart surgery. Cardiopulmonary bypass (CPB) time,age, nutritional status, thymectomy, and genetic variants, such as toll-like receptor(TLR) 2 and toll-interacting protein (TOLLIP) polymorphism affect immuneresponse. Information regarding those factors in the development of sepsis andimmune response after open heart surgery is still limited.Objectives: To understand the role of TLR 2 and TOLLIP polymorphism, as wellas other risk factors, in the development of sepsis and immune response followingopen heart surgery to develop the best strategy in open heart surgery in children.Methods: Longitudinal study with consecutive sampling were done in children <1year old who underwent open heart surgery. Blood sample was obtained to checkfor TLR2 Arg677Trp polymorphism, TLR2 N199N polymorphism, TOLLIPrs5743867 polymorphism, the numbers of intracellular interferon γ CD4 and CD8,TLR2 expression in Dendritic cells, and NK cells. Patient then underwent openheart surgery. Thymectomy was done as indicated and CPB time was recorded.After surgery, patient was monitored for signs of sepsis and immune response waschecked.Results: Out of 108 patients involved in this study, 21.3% developedpostoperative sepsis. TLR2 Arg677Trp polymorphism was found in all patients,TLR2 N199N polymorphism was found in 92.6% of the patients, and TOLLIPrs5743867 polymorphism was found in 52.8% of the patients. TLR2 N199Npolymorphism and thymectomy were not included in multivariate analysis.TOLLIP rs5743867 polymorphism (p = 0.358) reduced the risk of sepsis, CPBtime ≥90 menit (p = 0.002), neonates (p = 0.032), and severe malnutrition (p =0.558) increased the risk of postoperative sepsis. Immune response?s counts varyin each category, but were generally lower in patients who developedpostoperative sepsis.Conclusion: Cardiopulmonary bypass time and neonates significantly influencedthe risk and hazard of postoperative sepsis. Further investigation on the role ofTLR2 N199N and TOLLIP rs5743867 polymorphism are necessary to providemore comprehensive explanation on the development of postoperative sepsis andthe immune response after open heart surgery;Background: Sepsis is one of the complications in children with congenital heartdefect who underwent open heart surgery. Cardiopulmonary bypass (CPB) time,age, nutritional status, thymectomy, and genetic variants, such as toll-like receptor(TLR) 2 and toll-interacting protein (TOLLIP) polymorphism affect immuneresponse. Information regarding those factors in the development of sepsis andimmune response after open heart surgery is still limited.Objectives: To understand the role of TLR 2 and TOLLIP polymorphism, as wellas other risk factors, in the development of sepsis and immune response followingopen heart surgery to develop the best strategy in open heart surgery in children.Methods: Longitudinal study with consecutive sampling were done in children <1year old who underwent open heart surgery. Blood sample was obtained to checkfor TLR2 Arg677Trp polymorphism, TLR2 N199N polymorphism, TOLLIPrs5743867 polymorphism, the numbers of intracellular interferon γ CD4 and CD8,TLR2 expression in Dendritic cells, and NK cells. Patient then underwent openheart surgery. Thymectomy was done as indicated and CPB time was recorded.After surgery, patient was monitored for signs of sepsis and immune response waschecked.Results: Out of 108 patients involved in this study, 21.3% developedpostoperative sepsis. TLR2 Arg677Trp polymorphism was found in all patients,TLR2 N199N polymorphism was found in 92.6% of the patients, and TOLLIPrs5743867 polymorphism was found in 52.8% of the patients. TLR2 N199Npolymorphism and thymectomy were not included in multivariate analysis.TOLLIP rs5743867 polymorphism (p = 0.358) reduced the risk of sepsis, CPBtime ≥90 menit (p = 0.002), neonates (p = 0.032), and severe malnutrition (p =0.558) increased the risk of postoperative sepsis. Immune response?s counts varyin each category, but were generally lower in patients who developedpostoperative sepsis.Conclusion: Cardiopulmonary bypass time and neonates significantly influencedthe risk and hazard of postoperative sepsis. Further investigation on the role ofTLR2 N199N and TOLLIP rs5743867 polymorphism are necessary to providemore comprehensive explanation on the development of postoperative sepsis andthe immune response after open heart surgery;Background: Sepsis is one of the complications in children with congenital heartdefect who underwent open heart surgery. Cardiopulmonary bypass (CPB) time,age, nutritional status, thymectomy, and genetic variants, such as toll-like receptor(TLR) 2 and toll-interacting protein (TOLLIP) polymorphism affect immuneresponse. Information regarding those factors in the development of sepsis andimmune response after open heart surgery is still limited.Objectives: To understand the role of TLR 2 and TOLLIP polymorphism, as wellas other risk factors, in the development of sepsis and immune response followingopen heart surgery to develop the best strategy in open heart surgery in children.Methods: Longitudinal study with consecutive sampling were done in children <1year old who underwent open heart surgery. Blood sample was obtained to checkfor TLR2 Arg677Trp polymorphism, TLR2 N199N polymorphism, TOLLIPrs5743867 polymorphism, the numbers of intracellular interferon γ CD4 and CD8,TLR2 expression in Dendritic cells, and NK cells. Patient then underwent openheart surgery. Thymectomy was done as indicated and CPB time was recorded.After surgery, patient was monitored for signs of sepsis and immune response waschecked.Results: Out of 108 patients involved in this study, 21.3% developedpostoperative sepsis. TLR2 Arg677Trp polymorphism was found in all patients,TLR2 N199N polymorphism was found in 92.6% of the patients, and TOLLIPrs5743867 polymorphism was found in 52.8% of the patients. TLR2 N199Npolymorphism and thymectomy were not included in multivariate analysis.TOLLIP rs5743867 polymorphism (p = 0.358) reduced the risk of sepsis, CPBtime ≥90 menit (p = 0.002), neonates (p = 0.032), and severe malnutrition (p =0.558) increased the risk of postoperative sepsis. Immune response?s counts varyin each category, but were generally lower in patients who developedpostoperative sepsis.Conclusion: Cardiopulmonary bypass time and neonates significantly influencedthe risk and hazard of postoperative sepsis. Further investigation on the role ofTLR2 N199N and TOLLIP rs5743867 polymorphism are necessary to providemore comprehensive explanation on the development of postoperative sepsis andthe immune response after open heart surgery;Background: Sepsis is one of the complications in children with congenital heartdefect who underwent open heart surgery. Cardiopulmonary bypass (CPB) time,age, nutritional status, thymectomy, and genetic variants, such as toll-like receptor(TLR) 2 and toll-interacting protein (TOLLIP) polymorphism affect immuneresponse. Information regarding those factors in the development of sepsis andimmune response after open heart surgery is still limited.Objectives: To understand the role of TLR 2 and TOLLIP polymorphism, as wellas other risk factors, in the development of sepsis and immune response followingopen heart surgery to develop the best strategy in open heart surgery in children.Methods: Longitudinal study with consecutive sampling were done in children <1year old who underwent open heart surgery. Blood sample was obtained to checkfor TLR2 Arg677Trp polymorphism, TLR2 N199N polymorphism, TOLLIPrs5743867 polymorphism, the numbers of intracellular interferon γ CD4 and CD8,TLR2 expression in Dendritic cells, and NK cells. Patient then underwent openheart surgery. Thymectomy was done as indicated and CPB time was recorded.After surgery, patient was monitored for signs of sepsis and immune response waschecked.Results: Out of 108 patients involved in this study, 21.3% developedpostoperative sepsis. TLR2 Arg677Trp polymorphism was found in all patients,TLR2 N199N polymorphism was found in 92.6% of the patients, and TOLLIPrs5743867 polymorphism was found in 52.8% of the patients. TLR2 N199Npolymorphism and thymectomy were not included in multivariate analysis.TOLLIP rs5743867 polymorphism (p = 0.358) reduced the risk of sepsis, CPBtime ≥90 menit (p = 0.002), neonates (p = 0.032), and severe malnutrition (p =0.558) increased the risk of postoperative sepsis. Immune response?s counts varyin each category, but were generally lower in patients who developedpostoperative sepsis.Conclusion: Cardiopulmonary bypass time and neonates significantly influencedthe risk and hazard of postoperative sepsis. Further investigation on the role ofTLR2 N199N and TOLLIP rs5743867 polymorphism are necessary to providemore comprehensive explanation on the development of postoperative sepsis andthe immune response after open heart surgery, Background: Sepsis is one of the complications in children with congenital heartdefect who underwent open heart surgery. Cardiopulmonary bypass (CPB) time,age, nutritional status, thymectomy, and genetic variants, such as toll-like receptor(TLR) 2 and toll-interacting protein (TOLLIP) polymorphism affect immuneresponse. Information regarding those factors in the development of sepsis andimmune response after open heart surgery is still limited.Objectives: To understand the role of TLR 2 and TOLLIP polymorphism, as wellas other risk factors, in the development of sepsis and immune response followingopen heart surgery to develop the best strategy in open heart surgery in children.Methods: Longitudinal study with consecutive sampling were done in children <1year old who underwent open heart surgery. Blood sample was obtained to checkfor TLR2 Arg677Trp polymorphism, TLR2 N199N polymorphism, TOLLIPrs5743867 polymorphism, the numbers of intracellular interferon γ CD4 and CD8,TLR2 expression in Dendritic cells, and NK cells. Patient then underwent openheart surgery. Thymectomy was done as indicated and CPB time was recorded.After surgery, patient was monitored for signs of sepsis and immune response waschecked.Results: Out of 108 patients involved in this study, 21.3% developedpostoperative sepsis. TLR2 Arg677Trp polymorphism was found in all patients,TLR2 N199N polymorphism was found in 92.6% of the patients, and TOLLIPrs5743867 polymorphism was found in 52.8% of the patients. TLR2 N199Npolymorphism and thymectomy were not included in multivariate analysis.TOLLIP rs5743867 polymorphism (p = 0.358) reduced the risk of sepsis, CPBtime ≥90 menit (p = 0.002), neonates (p = 0.032), and severe malnutrition (p =0.558) increased the risk of postoperative sepsis. Immune response’s counts varyin each category, but were generally lower in patients who developedpostoperative sepsis.Conclusion: Cardiopulmonary bypass time and neonates significantly influencedthe risk and hazard of postoperative sepsis. Further investigation on the role ofTLR2 N199N and TOLLIP rs5743867 polymorphism are necessary to providemore comprehensive explanation on the development of postoperative sepsis andthe immune response after open heart surgery]"