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"Latar belakang: Anak yang menjalani operasi jantung memiliki risiko tinggi yang bermakna terhadap kejadian morbiditas dan mortalitas pasca-bedah. Penggunaan obat-obatan vasoaktif dan inotropik yang tinggi sebagai dukungan hemodinamik pasca-bedah berhubungan dengan luaran yang buruk. Status hemodinamik yang buruk, menyebabkan meningkatnya dukungan obat-obatan vasoaktif dan inotropik yang dibutuhkan. Tujuan: Melihat hubungan skor vasoaktif-inotropik / vasoactive-inotropic score VIS dengan luaran jangka pendek pasien anak pasca-bedah jantung, termasuk kematian, morbiditas, komplikasi berat, dan faktor-faktor risiko yang berhubungan dengan komplikasi berat. Metode: Penelitian ini adalah kohort retrospektif pada 123 anak yang telah menjalani prosedur bedah jantung di cardiac intensive care unit CICU RSUPN Dr Cipto Mangunkusumo Jakarta pada periode Januari sampai Desember 2016. Data demografi, data pra-operasi, intra-operasi, pasca-operasi, mortalitas dan komplikasi diambil dari rekam medis. Skor vasoaktif-inotropik dihitung pada 24 jam pertama, 24 jam kedua dan total 48 jam pasca-bedah dan dianalisis hubungannya dengan komplikasi berat, selain itu juga dicatat faktor-faktor risiko yang berhubungan dengan terjadinya komplikasi berat. Hasil: Selama penelitian didapatkan PJB terbanyak yang dilakukan bedah jantung adalah ventricle septal defect 28,5 dan tetralogy Fallot 34,5. Pada 123 anak yang dilakukan bedah jantung, dijumpai 32 26 anak dengan VIS tinggi. Median VIS 24 jam pertama adalah 12 2-40, median VIS 24 jam kedua adalah 14 3-32, dan median VIS total 48 jam adalah 11 2-29. Obat inotropik yang paling banyak digunakan adalah dopamin 97,6 diikuti oleh milrinon 69,9 .VIS pada 24 jam pertama dengan nilai area di bawah kurva adalah 0,94.VIS yang tinggi berkaitan dengan lama rawat inap di rumah sakit lebih dari 14 hari [OR 4,1 IK 95, 1,4-11,7 ], kematian dalam 30 hari pasca-bedah [OR 44,5 IK 95, 9,3-212,5 ], kejadian henti jantung [OR 57,2 IK 95, 11,9-273,9 ], pemakaian ventilator > 7 hari [OR 25,2 IK 95, 2,9-214,5 ] dan kejadian gagal multi organ [OR 23,3 IK 95, 4,8-113,1 ]. Komplikasi pasca-bedah jantung terjadi sebesar 40 dan komplikasi berat terjadi pada 30 anak 24,4. Komplikasi pasca-bedah jantung terbanyak adalah low cardiac output syndrome pada 48 39. Komplikasi berat meliputi kematian dalam 30 hari pasca-bedah terjadi pada 18 14,6 anak, henti jantung 20 16,3 anak, operasi jantung ulang 5 4,1 anak, dan gagal multi organ 13 10,6 anak. Faktor risiko yang berhubungan dengan meningkatnya komplikasi pasca-bedah jantung yang berat adalah peningkatan kadar laktat darah [OR 7,4 IK 95 2,0-26,9 ], dan skor vasoaktif-inotropik yang tinggi pasca-bedah [OR 30,5 IK 95 7,6-122,3 ]. Kesimpulan: VIS tinggi pasca-bedah jantung, berhubungan bermakna dengan kematian dan komplikasi berat pasca-bedah. VIS 24 jam pertama pasca-bedah jantung merupakan pemeriksaan yang sederhana dalam memberikan informasi berharga tentang luaran pasca-bedah jantung. Faktor risiko yang berhubungan dengan komplikasi berat pasca-bedah jantung adalah peningkatan kadar laktat dan nilai VIS yang tinggi pasca-bedah.

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Background: Children undergoing heart surgery are at high risk for significant post operative morbidity and mortality. The use of high vasoactive and inotropic suport after cardiac surgery was associated with poor outcome. The more severe the hemodynamic state, a higher vasoactive inotropic support were needed.

Objective: To determine the association between vasoactive inotropic support and clinical outcome in children after cardiac surgery, including mortality, complication or morbidity, major complications, and the risk factors associated with major adverse events major complications.

Methods: This is a retrospective analysis of the 123 children who underwent cardiac surgery at pediatric cardiac surgery intensive care unit from January to December 2016. Multiple demographic, pre operative, intra operative, post operative variables were recorded, vasoactive inotropic score VIS were assessed at the first 24 hours, second 24 hours and 48 hours after surgery and was analyzed for association with poor outcomes. Factors associated with the risk of developing major adverse events were also identified.

Results: A total of 123 patients were recruited, 32 26 were administered to high vasoactive inotropic score. Median VIS at first 24 hours, second 24 hours, and 48 hours after cardiac surgery were 12 2 40, 14 3 32, and 11 2 29, respectively. The most widely used vasoactive inotropic agents were dopamine 97,6 and milrinone 69,9. VIS at first 24 hours with area under curve was 0,94. There was a significant association between high VIS and poor outcome in children after cardiac surgery including 30 day mortality OR 44,5 IK 95, 9,3 212,5, prolonged hospital length of stay OR 4,1 IK 95, 1,4 11,7, cardiac arrest OR 57,2 IK 95, 11,9 273,9, prolonged mechanical ventilator support OR 25,2 IK 95, 2,9 214,5, and multiple organ failure OR 23,3 IK 95, 4,8 113,1. The most complication occurred after cardiac surgery was low cardiac output syndrome 39. Further, 30 24,4 of recruited patients had major adverse events major complications, including 30 day mortality in 18 14,6, cardiac arrest in 20 16,3, the need for re operation in 5 4,1, and multiple organ failure in 13 10,6 children. Factors associated with the occurrence of major complications were increase in blood lactate OR 7,4 IK 95 2,0 26,9 and high vasoactive inotropes score after cardiac surgery OR 30,5 IK 95 7,6 122,3.

Conclusion: High vasoactive inotropic score after pediatric cardiac surgery was significantly associated with mortality and other poor outcomes. VIS at first 24 hours after cardiac surgery is a simple clinical tool that can provide valuable information regarding likely length of intubation, hospital stay and poor outcomes. VIS at 24 hours performs better than VIS in the first 48 hours and total 48 hours after surgery in predicting poor short term outcomes. Increase in blood lactate, and high vasoactive inotropes score after cardiac surgery are associated with mortality and other major complications in children after cardiac surgery."

"[ABSTRAKLatar belakang: Luaran pasca-bedah jantung penting diketahui untuk menilai kinerja pelayanan bedah jantung anak, sehingga kualitas pelayanan dapat ditingkatkan.Tujuan: Mengetahui luaran jangka pendek (mortalitas, komplikasi pasca-bedah berat lain, dan komplikasi pasca-bedah yang berat) pada anak yang dilakukan bedah jantung. Selain itu, ingin mengetahui faktor risiko terjadinya komplikasi berat pasca-bedah jantung dan membuat sistem skor dari faktor-faktor risiko tersebut.Metode: Setiap anak dengan penyakit jantung yang dilakukan operasi jantung di RSUPN Dr Cipto Mangunkusumo Jakarta sejak April 2014 sampai Maret 2015 diikuti setiap hari sampai pasien pulang atau meninggal. Data demografis, mortalitas, morbiditas atau komplikasi pasca-bedah jantung, dan faktor risiko terjadinya morbiditas pasca-operasi yang berat diambil dari rekam medis. Pasien yang sudah pulang dari rumah sakit, dalam waktu 30 hari pasca-operasi dihubungi untuk mendapatkan data kondisi pasien dalam waktu tersebut (hidup atau meninggal).Hasil: Selama penelitian didapatkan 258 anak dilakukan bedah jantung. PJB terbanyak yang dilakukan bedah jantung adalah ventricle septal defect (28,7%) dan tetralogy of Fallot (24,4%). Komplikasi pasca-bedah jantung terjadi pada 217 (84,1%) anak dan komplikasi berat terjadi pada 49 anak (19%). Komplikasi pasca-bedah jantung terbanyak adalah hipokalsemia pada 163 (63,2%) anak, hiperglikemia 159 (61,6%), low cardiac output syndrome 52 (20,2%), aritmia 48 (18,6%), sepsis 45 (17,4%), dan efusi pleura 39 (15,1%). Komplikasi berat meliputi in-hospital mortality terjadi pada 33 (12,7%) anak dan mortalitas dalam waktu 30 hari pasca-bedah jantung terjadi pada 35 (13,6%) anak, henti jantung 13 (5%), operasi jantung ulang 10 (3,9%), dan gagal organ multipel 19 (7,4%). Faktor risiko yang berhubungan dengan meningkatnya komplikasi pasca-bedah jantung yang berat adalah peningkatan kadar laktat darah [OR 30,7 (IK 95% 8,1-117,6)], PJB sianotik [OR 4,4 (IK 95% 1,2-15,8), dan pemakaian inotropik yang tinggi [OR 7,8 (IK 95% 1,6-38,9)]. Skor faktor risiko ≥ 3 mampu memprediksi anak yang mengalami komplikasi berat pasca-bedah jantung dengan sensitivitas skor 93,9% dan spesifisitas skor 84,2%, dan area di bawah kurva receiver operating characteristic (ROC) adalah 0,94.Simpulan: Mortalitas di rumah sakit pasca-bedah jantung anak sebesar 12,7% dan mortalitas 30 hari pasca-bedah 13,6%. Komplikasi berat lain pasca-bedah 13,6%. Faktor risiko yang berhubungan dengan meningkatnya komplikasi pasca-bedah jantung yang berat adalah peningkatan kadar laktat darah, PJB sianotik, dan pemakaian inotropik tinggi pasca-bedah jantung. Skor faktor risiko ≥ 3 mampu memprediksi anak yang mengalami komplikasi berat pasca-bedah jantung dengan sensitivitas skor 93,9% dan spesifisitas skor 84,2%.

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ABSTRACTBackground: Outcome of children with cardiac surgery is important to evaluate the performance of cardiac surgery program. Identifying the risk factors for major adverse events after cardiac surgery is also important to improve patient care.Objective: To evaluate the incidence of short-term outcome in children after cardiac surgery, including mortality, complication or morbidity, major complications, and the risk factors associated with major adverse events (major complications) at the Dr Cipto Mangunkusumo Hospital, Indonesia.Methods: A prospective observational study was conducted from April 2014 until March 2015. All children conducted cardiac surgery, were monitored from the time the cardiac surgery performed until patients were discharged or deceased. During the follow up of all recruited patients, factors associated with the risk of developing major adverse events were identified.Results: A total of 258 patients were recruited during the study period. Of the total, 134 (51.9%) were female. The mean age of the patients was 53.3±3.8 months. Among the patients, 217 (84.1%) had complications. The most complications occurred after cardiac surgery were hypocalcaemia in 163 (63.2%), hyperglycemia in 159 (61.6%), low cardiac output syndrome in 52 (20.2%), arrhythmia in 48 (18.6%), sepsis in 45 (17.4%), and pleural effusion in 39 (15.1%) children. Further, 49 (19%) of recruited patients had major adverse events (major complications), including in-hospital mortality in 33 (12.7%) and 30-day mortality in 35 (13.6%), cardiac arrest in 13 (5%), the need for re-operation in 10 (3.9%), and multiple organ failure in 19 (7.4%) children. Factors associated with the occurrence of major complications were increase in blood lactate [OR 30.7 (95% CI 8.1-117.6)], cyanotic congenital heart disease [OR 4.4 (95% CI 1.2-15.8), and high inotropes on leaving operating room [OR 7.8 (95% CI 1.6-38.9)]. Risk factor score ≥3 could predict major complications after cardiac surgery with sensitivity of 93.9% and specificity of 84.2%, and area under receiver operating characteristic (ROC) curve was 0.94.Conclusion: In-hospital mortality after paediatric cardiac surgery at Dr Cipto Mangunkusumo hospital is 12,7% and 30-day mortality is 13,6%. Increase in blood lactate, cyanotic congenital heart disease, and high inotropes on leaving operating room are associated with mortality and other major complications in children following cardiac surgery. Risk score ≥ 3 can predict the development of major complication in children after cardiac surgery with sensitivity 93,9% and specificity 84,2%.;Background: Outcome of children with cardiac surgery is important to evaluate the performance of cardiac surgery program. Identifying the risk factors for major adverse events after cardiac surgery is also important to improve patient care.Objective: To evaluate the incidence of short-term outcome in children after cardiac surgery, including mortality, complication or morbidity, major complications, and the risk factors associated with major adverse events (major complications) at the Dr Cipto Mangunkusumo Hospital, Indonesia.Methods: A prospective observational study was conducted from April 2014 until March 2015. All children conducted cardiac surgery, were monitored from the time the cardiac surgery performed until patients were discharged or deceased. During the follow up of all recruited patients, factors associated with the risk of developing major adverse events were identified.Results: A total of 258 patients were recruited during the study period. Of the total, 134 (51.9%) were female. The mean age of the patients was 53.3±3.8 months. Among the patients, 217 (84.1%) had complications. The most complications occurred after cardiac surgery were hypocalcaemia in 163 (63.2%), hyperglycemia in 159 (61.6%), low cardiac output syndrome in 52 (20.2%), arrhythmia in 48 (18.6%), sepsis in 45 (17.4%), and pleural effusion in 39 (15.1%) children. Further, 49 (19%) of recruited patients had major adverse events (major complications), including in-hospital mortality in 33 (12.7%) and 30-day mortality in 35 (13.6%), cardiac arrest in 13 (5%), the need for re-operation in 10 (3.9%), and multiple organ failure in 19 (7.4%) children. Factors associated with the occurrence of major complications were increase in blood lactate [OR 30.7 (95% CI 8.1-117.6)], cyanotic congenital heart disease [OR 4.4 (95% CI 1.2-15.8), and high inotropes on leaving operating room [OR 7.8 (95% CI 1.6-38.9)]. Risk factor score ≥3 could predict major complications after cardiac surgery with sensitivity of 93.9% and specificity of 84.2%, and area under receiver operating characteristic (ROC) curve was 0.94.Conclusion: In-hospital mortality after paediatric cardiac surgery at Dr Cipto Mangunkusumo hospital is 12,7% and 30-day mortality is 13,6%. Increase in blood lactate, cyanotic congenital heart disease, and high inotropes on leaving operating room are associated with mortality and other major complications in children following cardiac surgery. Risk score ≥ 3 can predict the development of major complication in children after cardiac surgery with sensitivity 93,9% and specificity 84,2%., Background: Outcome of children with cardiac surgery is important to evaluate the performance of cardiac surgery program. Identifying the risk factors for major adverse events after cardiac surgery is also important to improve patient care.Objective: To evaluate the incidence of short-term outcome in children after cardiac surgery, including mortality, complication or morbidity, major complications, and the risk factors associated with major adverse events (major complications) at the Dr Cipto Mangunkusumo Hospital, Indonesia.Methods: A prospective observational study was conducted from April 2014 until March 2015. All children conducted cardiac surgery, were monitored from the time the cardiac surgery performed until patients were discharged or deceased. During the follow up of all recruited patients, factors associated with the risk of developing major adverse events were identified.Results: A total of 258 patients were recruited during the study period. Of the total, 134 (51.9%) were female. The mean age of the patients was 53.3±3.8 months. Among the patients, 217 (84.1%) had complications. The most complications occurred after cardiac surgery were hypocalcaemia in 163 (63.2%), hyperglycemia in 159 (61.6%), low cardiac output syndrome in 52 (20.2%), arrhythmia in 48 (18.6%), sepsis in 45 (17.4%), and pleural effusion in 39 (15.1%) children. Further, 49 (19%) of recruited patients had major adverse events (major complications), including in-hospital mortality in 33 (12.7%) and 30-day mortality in 35 (13.6%), cardiac arrest in 13 (5%), the need for re-operation in 10 (3.9%), and multiple organ failure in 19 (7.4%) children. Factors associated with the occurrence of major complications were increase in blood lactate [OR 30.7 (95% CI 8.1-117.6)], cyanotic congenital heart disease [OR 4.4 (95% CI 1.2-15.8), and high inotropes on leaving operating room [OR 7.8 (95% CI 1.6-38.9)]. Risk factor score ≥3 could predict major complications after cardiac surgery with sensitivity of 93.9% and specificity of 84.2%, and area under receiver operating characteristic (ROC) curve was 0.94.Conclusion: In-hospital mortality after paediatric cardiac surgery at Dr Cipto Mangunkusumo hospital is 12,7% and 30-day mortality is 13,6%. Increase in blood lactate, cyanotic congenital heart disease, and high inotropes on leaving operating room are associated with mortality and other major complications in children following cardiac surgery. Risk score ≥ 3 can predict the development of major complication in children after cardiac surgery with sensitivity 93,9% and specificity 84,2%.]"

"Latar belakang: Hubungan antara HbA1c dengan kejadian mortalitas dan morbiditas pada pasien diabetes yang menjalani CABG telah dijelaskan dalam banyak penelitian sebelumnya. Namun, peran HbA1c pada populasi pasien non-diabetes dengan PJK yang menjalani BPAK belum pernah dilakukan, khususnya di Indonesia. Penelitian ini bertujuan untuk mengetahui apakah kadar HbA1c praoperasi memiliki hubungan dan dapat memprediksi keluaran awal pascaoperasi setelah BPAK pada pasien non-diabetes dengan penyakit arteri koroner. Metode: Penelitian ini merupakan studi kohort retrospektif pada pasien non-diabetes dengan penyakit jantung koroner yang menjalani BPAK sejak Januari 2022 hingga Desember 2023 di Pusat Jantung Nasional Harapan Kita. Kemudian, data kadar HbA1c praoperasi serta keluaran pascaoperasi yaitu mortalitas intrahospital dan morbiditas pascaoperasi seperti durasi penggunaan ventilator mekanik, lama rawat inap di ICU, lama rawat inap di rumah sakit, Major Adverse Cardiovascular Event (MACE), dan infeksi luka operasi diambil dari rekam medis pasien. Data variabel kontinu dinilai dengan menggunakan uji T atau uji Mann-Whitney U, sedangkan data nominal dinilai menggunakan uji Chi square atau Fischer. Analisis multivariat akan dilakukan lebih lanjut untuk hasil yang signifikan. Hasil: Sebanyak 391 subjek memenuhi kriteria dalam penelitian ini. Usia rata-rata subjek adalah 58,69 ± 8,29 tahun. Subjek dengan prediabetes (n = 268) memiliki perbedaan yang signifikan  secara statistik dalam median durasi ventilator dibandingkan dengan kelompok HbA1c normal (p = 0,009). Namun, tidak didapatkan hubungan yang signifikan antara HbA1c praoperasi dengan mortalitas intrarawat, lama rawat inap di ICU, lama rawat inap di rumah sakit, kejadian MACE, dan infeksi luka operasi pascaoperasi. Simpulan: Tidak terdapat hubungan antara HbA1c praoperasi pada pasien non-diabetes dengan PJK yang telah menjalani BPAK dengan mortalitas intrarawat, lama rawat inap di ICU, lama rawat inap di rumah sakit, kejadian MACE, dan infeksi luka operasi pascaoperasi. Pasien HbA1c normal praoperasi diasosiasikan signifikan secara statistik mempunyai durasi ventilasi mekanik yang lebih pendek dibandingkan pada pasien prediabetes dengan PJK yang telah menjalani BPAK.

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Background: The association between HbA1c with mortality and morbidity events in diabetic patients undergoing CABG have been explained in many previous studies. However, the predictive value of this in the non-diabetic patient population has not received sufficient attention, especially in Indonesia. This study investigated whether the pre-operative HbA1c level had an association and could predict early post-operative outcomes after CABG in non-diabetic patients with coronary artery disease. Methods: This retrospective cohort study involved non-diabetic patients with coronary artery disease who underwent CABG from January 2022 until December 2023 at National Cardiovascular Center Harapan Kita. Pre-operative HbA1c level and post-operative incidence of intrahospital mortality and morbidities such as mechanical ventilator duration, length of ICU stay, length of hospital stay, major adverse cardiovascular event (MACE), and sternal wound infections were collected. Continuous variable is assessed using T test or Mann- Whitney U test. Nominal data are assessed using Chi square or Fischer test. Multivariate analysis will be conducted further for significant results. Results: Three hundred-ninety-one subjects were involved in this study. The mean age of all subjects was 58.69 ± 8.29 years. Subjects with pre-diabetes (n = 268) have statistically significant difference in median ventilator duration compared to normal HbA1c group (p = 0.009). However, there was no significant association between pre-operative HbA1c and early post-operative intrahospital mortality, length of ICU stay, length of hospital stay, major adverse cardiovascular event (MACE), and sternal wound infections in this population. Conclusion: Pre-operative glycated hemoglobin level is not associated with early mortality, length of ICU stay, length of hospital stay and MACE. However, there is statistically significant lower mechanical ventilator duration in normal HbA1c compared to pre-diabetic patients with CAD who have undergone CABG."

"Latar Belakang: Penanda prognostik dapat menunjang tata laksana stroke iskemik (SI) akut. Protein neuroglobin (Ngb), yang berperan dalam transpor oksigen intrasel neuron dan mengurangi dampak hipoksia, adalah salah satu penanda potensial memenuhi fungsi tersebut.Metode: Studi potong lintang dilakukan pada pasien SI akut yang dirawat di RSUPN dr. Cipto Mangunkusumo pada Maret-April 2023. Sampel serum untuk pemeriksaan Ngb diambil pada tiga hari pasca awitan stroke, sedangkan modified Rankin scale (mRS), National Institutes of Health Stroke Scale (NIHSS), indeks Barthel (BI) dan Montreal Cognitive Assessment (MoCA-Ina) diperiksa pada hari ketujuh. Analisis kemaknaan dan kurva receiver operating characteristic (ROC) digunakan untuk mengetahui hubungan Ngb dengan luaran stroke iskemik akut.Hasil: Sebanyak 42 subjek menjalani analisis. Kadar Ngb serum lebih tinggi pada kelompok dengan skor mRS 3-6 dibandingkan 0-2 (12,42 ng/mL [3,57-50,43] vs 4,79ng/mL [2,25-37,32], p=0,005), dengan skor area di bawah kurva ROC sebesar 0,75. Kadar Ngb juga lebih tinggi pada kelompok dengan NIHSS pulang lebih tinggi (p=0,03), serta BI dan MoCA-Ina yang lebih rendah (p=0,01 dan p=0,002).Kesimpulan: Kadar Ngb serum pada SI akut yang lebih tinggi berkaitan dengan luaran fungsional jangka pendek yang lebih buruk. Penelitian lebih lanjut dibutuhkan sebelum terapan klinis.

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Background: Prognostic markers can optimize the management of acute ischemic stroke (AIS). The neuroglobin (Ngb), which plays a role in intraneuronal oxygen transport and reduces the effects of hypoxia, is a marker that may perform this function.

Methods: A cross-sectional study was conducted on AIS patients who were treated at RSUPN dr. Cipto Mangunkusumo in March-April 2023. Serum samples for Ngb examination were taken three days after the onset of stroke, while modified Rankin scale (mRS), National Institutes of Health Stroke Scale (NIHSS), Barthel index (BI) and Montreal Cognitive Assessment (MoCA-Ina) were examined on the seventh day. Significance analysis and receiver operating characteristic (ROC) curve were used to determine the relationship between Ngb and AIS outcomes.

Results: A total of 42 subjects underwent analysis. Serum Ngb levels were higher in subjects with mRS score of 3-6 than 0-2 (12.42 ng/mL [3.57-50.43] vs 4.79 ng/mL [2.25-37.32], p=0.005). The area under the ROC curve score was 0.75. Ngb levels were also higher in the group with higher NIHSS at discharge (p=0.03), lower BI (p=0.01) and lower MoCA-Ina score (p=0.002).

Conclusion: Higher serum Ngb levels in AIS are associated with poorer short-term functional outcomes. Further research is needed before clinical application."

"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: Pasien sindrom Down (Down?s syndrome/DS) berbeda dari anak normal karena memiliki banyak kelainan selain defek jantung yang dapat memengaruhi luaran pasca-operasi jantung. Sampai saat ini belum ada penelitian mengenai luaran pasca-operasi penyakit jantung bawaan (PJB) pada DS di pusat-pusat pelayanan jantung di Indonesia.Tujuan: Untuk mengetahui luaran jangka pendek dan mortalitas pada pasien DS yang dilakukan operasi jantung di RSUPN Cipto Mangunkusumo, Jakarta.Metode: Studi kohort retrospektif dan prospektif pada subjek anak dengan DS yang menjalani operasi koreksi PJB. Kontrol adalah anak tanpa DS yang masuk kriteria inklusi dan eksklusi, dengan matching rentang usia dan jenis penyakit jantung yang sama dengan pasien DS.Hasil: Sebanyak 57 pasien DS dan 43 non-DS yang telah menjalani operasi koreksi PJB diikutkan dalam penelitian. Karakteristik dasar antar kelompok tidak berbeda bermakna. Jenis PJB terbanyak pada DS adalah defek septum atrioventrikular (AVSD) dan defek septum ventrikel (VSD) masing-masing sebesar 31,6%, tetralogi Fallot (TF) 21%, defek septum atrium (ASD) 7%, duktus arteriosus persisten (PDA) 7% dan transposisi arteri besar (TGA)-VSD 1,8%. Lama rawat ruang rawat intensif (ICU) pada DS 1,9 (0,6-34) hari dibanding non-DS 1 (0,3-43), p=0,373. Lama penggunaan ventilator pada DS 19,9 (3-540) jam, non-DS 18 (3-600), p=0,308. Krisis hipertensi pulmoner (PH) tidak terjadi pada kedua kelompok, proporsi komplikasi paru pada DS 24,6% dibanding non-DS 14%, dan sepsis pada DS 28,1% dibanding non-DS 14% tidak berbeda bermakna. Proporsi blok atrioventrikular (AV) komplit pada DS 10,5% dan non-DS tidak ada, dengan p=0,036. Kematian di rumah sakit (RS) pada DS 8,8%, non-DS tidak ada, dengan p=0,068.Simpulan: Morbiditas dan mortalitas pasca-operasi jantung pada DS tidak terbukti lebih sering terjadi dibandingkan dengan non-DS.

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Background: Down syndrome patients different from normal child because many other genetic related aspects that can affect outcome after congenital heart surgery. Until now there has been no research on the outcome after congenital heart surgery on paediatric Down syndrome patients in Indonesia.

Objective: To determine the short term outcomes and mortality in DS patients who underwent heart surgery at Cipto Mangunkusumo hospital, Jakarta.

Methods: A prospective and retrospective cohort study was conducted to subject with DS who underwent heart surgery from July 2007- April 2015. Control group was patients without DS who underwent heart surgery with matching on age and type of heart defects.

Results: A total of 57 DS patients and 43 non-DS patients were recruited during study period. Basic characteristics between groups were not significantly different. Most type of CHD in patients with DS were AVSD and VSD respectively in 18 (31,6%), tetralogi of Fallot 12 (21%), ASD 4 (7%), PDA 4 (7%) and TGA-VSD 1 (1,8%) patients. Duration of ICU stay in patients with DS was 1,9 (0,6-34) days compared to non-DS patients 1 (0,3-43) days, p=0,373. Duration of mechanical ventilation in patients with DS was 19,9 (3-540) hours, compared to non-DS patients 18 (3-600) hours, p=0,308. Pulmonary hypertension crisis was not occurred in both groups. Pulmonary complication in patients with DS was 14 (24,6%) compared to non-DS 6 (14%) patients, and sepsis in patients with DS was 16 (28,1%) compared to non-DS 6 (14%) patients, there was no difference. Complete AV block in patients with DS was 6 (10,5%) compared none in patients with non-DS, p=0,036. In-hospital mortality in patients with DS was 5 (8,8%), compared none in patients with non-DS, significantly different with p=0,068.

Conclusion: Morbidity and mortality after cardiac surgery in DS is not proven to be more frequent compared to non-DS."

"Sindrom koroner akut (SKA) merupakan masalah utama penyakit jantung yang merupakan penyebab kematian tertinggi setelah stroke di Indonesia. SKA dapat dinilai keparahannya melalui skor Gensini dan prognosisnya melalui kejadian Major Adverse Cardiac Event (MACE). High Sensitive Troponin T (hsTroponin T) adalah biomarker yang direkomendasikan beberapa badan internasional dalam mendiagnosis infark miokard. Pada pasien SKA yang disertai penyakit ginjal kronik (PGK) akan mempengaruhi hasil pemeriksaan hsTroponin T. Hal ini disebabkan oleh kadar ureum darah yang tinggi bersifat toksik dan kondisi PGK menurunkan fungsi ginjal sehingga mempengaruhi kadar hsTroponin T. Penelitian ini bertujuan mengetahui hubungan hstroponin T dan ureum dengan skor Gensini, MACE jangka pendek pada pasien SKA yang disertai PGK di RSUPN dr. Cipto Mangunkusumo. Metode penelitian adalah potong lintang dilakukan pada bulan Januari-Oktober 2018. Subjek penelitian meliputi seluruh pasien yang mengikuti penelitian terdahulu “ Pengaruh Beta 2- Mikroglobulin dan Fibroblast Growth Factor 23 terhadap Keparahan Koroner dan Major Adverse Cardiac Event pada Pasien Sindrom Koroner Akut dengan Penyakit Ginjal Kronik”. Kadar hsTroponin T dan ureum subjek SKA dengan PGK dihubungkan dengan skor Gensini dan kejadian MACE jangka pendek. Terdapat 80 subjek SKA dengan PGK, terdiri dari 63 subjek STEMI -NSTEMI dengan peningkatan hsTroponin T dan 17 subjek UAP. Terdapat 34 subjek mengalami MACE diantaranya ada 11 subjek yang meninggal. Tidak terdapat korelasi kadar hsTroponin T dengan skor Gensini, r = 0,095, p=0,401 dan juga ureum dengan skor Gensini, r = 0,107, p = 0,343. Peningkatan kadar hsTroponin T memberikan peningkatan Odds Ratio (OR) sebesar 1,59 dan ureum OR 3,14 dengan p<0,05 terhadap kejadian MACE jangka pendek. Titik potong hsTroponin T terhadap kejadian MACE jangka pendek sebesar 150,5ng/L dengan sensitivitas 53,5%, spesifisitas 55,3%, nilai prediksi positif (NPP) 48%, nilai prediksi negatif (NPN) 63,33%. Titik potong ureum terhadap kejadian MACE jangka pendek 47,45mg/dL dengan sensitivitas 52,9%, spesifisitas 47,8%, NPP 63,63%, NPN 63,79%. Berdasarkan hasil tersebut peningkatan kadar hsTroponin T diatas 150,5ng/L dan ureum47,45mg/dL berperan dalam meningkatkan risiko kejadian terjadinya MACE jangka pendek dengan OR 1,59 dan 3,14 pada pasien SKA dengan PGK. Gambaran kadar hsTroponin T bervariasi pada setiap stadium PGK tetapi ada kecenderungan peningkatan kadar seiring dengan peningkatan stadium PGK, untuk itu diperlukan penelitian lebih lanjut untuk mendapatkan gambaran kadar hsTroponin T yang lebih jelas.

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Acute Coronary Syndrome(ACS) is the main problem in heart disease which is the highest mortality after stroke in Indonesia. ACS can be assess the severity degree by Gensini scoring and its prognosis by Major Adverse Cardiac Event (MACE). High sensitive Troponin T (hsTroponin T) is biomarker that recomended by several international associations in diagnosing miocard infarct. Level of hs Troponin T can be affected in patients with ACS and chronic kidney disease (CKD), because lower filtration in CKD and high level ureum has toxic effect.This research aimed in knowing the relation of hsTroponin T and ureum with Gensini score, short term MACE, in ACS and CKD in RSUPN dr. Cipto Mangunkusumo. Methods using cross sectional in January-October 2018. All patients in elder research “ Pengaruh Beta 2- Mikroglobulin dan Fibroblast Growth Factor 23 terhadap Keparahan Koroner dan Major Adverse Cardiac Event pada Pasien Sindrom Koroner Akut dengan Penyakit Ginjal Kronik”, are included in this research, and then search for the correlation between hsTroponin T, ureum and Gensini score, short term MACE. There are 80 subjects ACS with CKD, 63 subjects with STEMI -NSTEMI (ST Elevation Miocard Infarct-Non ST Elevation Miocard Infarct) and elevated level of hs-troponin T, 17 subjects UAP (Unstable Angina Pectoris), 34 subjects MACE and 11 subjects within were died. There is no correlation between hsTroponin T and Gensini score is not , r=0,095 with p=0,401. There is no correlation between ureum and Gensini score r= 0,107 with p=0,343. Level of hsTroponin T and ureum has odds ratio OR= 1,59 and 3,14, p<0,05 towards short term MACE. The cut off for hsTroponin T towards short term MACE is 150,5ng/L with sensitivity 53,5%, specificity 55,3%, positive predictive value (PPV) 48%, negative predictive value (NPV) 63,33%. The cut off for ureum towards short term MACE is 47,45mg/dL with sensitivity 52,9%, specificity 47,8%, PPV 63,63%,NPV 63,79%. The descriptions of hsTroponin T level are various in every stage of CKD. According to that results, ascending level in hsTroponin T with cut off 150,5ng/L and ureum 47,45mg/dL has an impact in short term MACE (OR hsTroponin T=1,59 and ureum=3,14) in patients with ACS and CKD. The descriptions of level hsTroponin T are variety, but have tendency to escalate level hsTroponin T in every stage of CKD and need advance research to have clear descriptions."

"Penggunaan ventilasi mekanik yang memanjang merupakan salah satu komplikasi utama pada pasien pasca-bedah jantung yang dapat menyebabkan morbiditas dan mortalitas. Prediksi lama penggunaan ventilasi mekanik merupakan hal penting dalam penatalaksanaan pasien operasi jantung. Skor ACEF (Age, Creatinine, Ejection Fraction) merupakan sistem prediksi sederhana dengan menggunakan tiga variabel pra-bedah yang diukur secara objektif, memiliki performa yang baik dalam memprediksi morbiditas dan mortalitas pada pasien pasca-bedah jantung. Penggunaan skor ACEF dalam memprediksi kejadian penggunaan ventilasi mekanik memanjang pasca-bedah jantung belum ada, namun variabel yang dipakai pada sistem skor ini merupakan prediktor terkuat kejadian penggunaan ventilasi mekanik memanjang pasca-bedah jantung. Penelitian ini bertujuan untuk mengetahui kemampuan skor ACEF dalam memprediksi kejadian penggunaan ventilasi mekanik yang memanjang pada pasien pasca-bedah jantung dewasa di PJT RSCM. Penelitian ini adalah penelitian kohort retrospektif yang melibatkan 206 subjek penelitian yang menjalani operasi jantung terbuka di Pelayanan Jantung Terpadu RSCM. Hasil penelitian ini didapatkan hasil AUC = 0,6336 (95% CI : 0,55-0,71), nilai sensitivitas sebesar 35,8%, spesivisitas 88%, dan akurasi 67,48%. Dari hasil yang diperoleh, dapat disimpulkan Skor ACEF memiliki kemampuan prediksi yang kurang dalam memprediksi kejadian penggunaan ventilasi mekanik memanjang pada pasien pasca-bedah jantung.

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Prolonged mechanical ventilation is one of the main complications in post-cardiac surgery patients that can cause morbidity and mortality. Prediction of the duration mechanical ventilation is important in the management of cardiac surgery patients. The ACEF score (Age, Creatinine, Ejection Fraction) is a simple prediction system using three measured pre-operative variables objectively, which performs well in predicting post-operative morbidity and mortality in cardiac surgery patients. The use of the ACEF score in predicting prolonged mechanical ventilation after cardiac surgery does not yet exist, but the variables used in this scoring system are the strongest predictors of prolonged mechanical ventilation after cardiac surgery. This study aims to determine the ability of the ACEF score to predict the incidence of prolonged of mechanical ventilation in post-cardiac surgery patients at RSCM PJT. This study is a retrospective cohort study involving 206 subjects who underwent open heart surgery at PJT RSCM. The results of this study showed that AUC = 0.6336 (95% CI: 0.55-0.71), the sensitivity is 35,8%; specificity is 88%, and accuracy is 67,48%. From the results obtained, it can be concluded that the ACEF score has poor predictive ability in predicting the incidence of prolonged mechanical ventilation in post-cardiac surgery patients."

"Latar Belakang: Endokarditis Infektif (EI) dalam 3 dekade terakhir masih memiliki insidensi, beban morbiditas, dan mortalitas yang tinggi, mencapai 30% dalam 1 tahun. Beragam predisposisi insiden EI menunjukkan perubahan seiring dengan perkembangan tatalaksana dan tindakan medis yang seringkali menjadi pemicu baru EI itu sendiri.Tujuan: Penelitian ini bertujuan untuk mengidentifikasi faktor-faktor prediktor mortalitas dan luaran klinis pasien EI aktif sisi jantung kiri dalam jangka pendek dan jangka panjang. Penelitian ini juga menjadi penelitian awal untuk mengetahui model prediktor stratifikasi risiko pasien EI aktif sisi jantung kiri di Indonesia.Metode: Dilakukan studi kohort retrospektif terhadap 376 pasien yang mengalami EI aktif sisi jantung kiri pada periode 1 Januari 2013 – 31 Desember 2022. Analisis bivariat dan multivariat dilakukan untuk mengidentifikasi prediktor luaran klinis jangka pendek dan jangka panjang. Dilakukan juga pembuatan sistem skor prediktor mortalitas awal untuk pasien EI aktif.Hasil: Terdapat 376 pasien EI aktif sisi jantung kiri yang kemudian mendapatkan tatalaksana antibiotik serta menjalani operasi sebanyak 56,6% pasien. Studi ini menunjukkan angka mortalitas jangka pendek sebesar 18,6% dan mortalitas jangka panjang 13,2%. Selain itu, didapatkan pula profil morbiditas selama perawatan fase aktif dengan kejadian sepsis 27,1%, perawatan ruang intensif >10 hari 18,6%, penggunaan ventilator mekanik >7 hari 11,4%, kejadian stroke sebanyak 28,5%, dan gagal ginjal akut 57,7%. Studi ini juga menunjukkan model awal skor prediktor mortalitas jangka pendek dan jangka panjang pada studi ini didapatkan berturut-turut dengan AUC 0,935 (IK95% 0,902 – 0,969; p <0,001; uji H-L 0,386) dan AUC 0,733 (IK95% 0,614 – 0,852; p <,001; uji H-L 0,530).Kesimpulan: Faktor-faktor prediktor luaran mortalitas jangka pendek pasien EI aktif sisi jantung kiri meliputi kapasitas fungsional NYHA kelas III-IV, keterlibatan vegetasi katup aorta, ukuran vegetasi >10mm, penggunaan antibiotik inkomplit, sepsis, dan penggunaan terapi pengganti ginjal. Sementara itu, prediktor luaran mortalitas jangka panjang meliputi tidak dilakukannya prosedur operasi, komplikasi paravalvular, serta infeksi Streptoccocus non-viridans.

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Background: Infective endocarditis (IE) in the last 3 decades still has a high incidence, burden of morbidity, and mortality reaching 30% in 1 year. Various predispositions for IE incidents show changes along with developments in medical management and actions which often become new triggers for IE itself.

Objective: This study aims to identify predictors for mortality and clinical outcomes in patients with active left-sided IE in short-term and long term. This study is also initial research to determine the risk stratification predictor model for patients with active IE on the left side of the heart in Indonesia.

Methods: A retrospective cohort study was conducted on 376 patients who experienced active left- sided IE in the period 1 January 2013 – 31 December 2022. Bivariate and multivariate analyzes were performed to identify predictors of short-term and long-term clinical outcomes. Mortality risk predictor score model was also created for active IE patients.

Results: There were 376 active left-sided IE patients who then received antibiotic treatment and 56.6% of the patients underwent surgery. This study showed a short-term mortality rate of 18.6% and a long-term mortality rate of 13.2%. Apart from that, the morbidity profile during the active phase of treatment was also obtained with the incidence of sepsis in 27.1% cases, intensive care > 10 days in 18.6% cases, use of mechanical ventilators > 7 days in 11.4% cases, stroke incidence in 28.5% cases, and acute renal failure in 57.7% cases. This study also shows initial model of short- term and long-term mortality predictor score respectively with AUC 0,935 (95%CI 0,902 – 0,969; p <0,001; H-L test 0,386) and AUC 0,733 (95%CI 0,614 – 0,852; p <,001; H-L test 0,530).

Conclusion: Predictors for short-term mortality outcomes in patients with active left-sided IE include NYHA class III-IV functional capacity, involvement of aortic valve vegetation, vegetation size >10mm, incomplete use of antibiotics, sepsis, and use of renal replacement therapy. Meanwhile, predictors of long-term mortality outcomes include not having a surgical procedure, paravalvular complications, and Streptoccocus non-viridans infection."

"Background:Cardiac rehabilitation in patients with Coronary Artery Bypass Surgery (CABG) is an effective way in reducing mortality in patients with coronary heart disease (CHD). The presence of impaired cardiac autonomic function is increase the risk of arrhythmias and sudden death. Exercise training as one component of cardiac rehabilitation can improve autonomic function that can be measured indirectly with Heart Rate Recovery (HRR). The aim of this study is to assess the effect of the frequency of physical exercise on improved of HRR.Metod:The data used for this analysis include 100 patients who underwent second phase of cardiac rehabilitation after CABG at Pusat Jantung Nasional Harapan Kita, Jakarta between July and October 2013. Patients were categorized into group I (exercise 3 times a week) : 40 people and group II (5 times a week exercise) : 60 people. Heart rate recovery was measured with a 6 minute walk test (6MWT). Measurements were performed 2 times, in the early phase and the evaluation phase after 12 times. Increased HRR from both groups were analyzed by linear regression analysis.Result :In our study, age, gender, diabetes mellitus, psychological, smoking, coronary artery bypass surgery and the duration of aortic cross clamp did not affect the increase of HRR. Five times a week exercise training gives significant increase of HRR compare to 3 times a week exercise training after analyzed multivariate linear regression ( RR 2.9, 95% KI 1.53 to 4.40, p <0.001 ).Conclusion:Frequency of physical exercise 5 times a week give a better response to the increase in HRR than exercise 3 times a week.

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Latar Belakang:Rehabilitasi jantung pada pasien Bedah Pintas Arteri Koroner (BPAK) merupakan tindakan efektif dalam menurunkan mortalitas pada pasien dengan Penyakit Jantung Koroner (PJK). Adanya gangguan fungsi otonom jantung dikatakan meningkatkan risiko aritmia dan kematian mendadak. Latihan fisik sebagai salah satu komponen rehabilitasi jantung dapat meningkatkan fungsi otonom yang dapat diukur secara tidak langsung dengan Heart Rate Recovery (HRR). Penelitian ini bertujuan untuk menilai pengaruh frekuensi latihan fisik terhadap peningkatan HRR.Metode:Sebanyak 100 pasien pasca BPAK yang melakukan rehabilitasi jantung fase II dipilih secara konsekutif sejak 1 Juli ? 15 Oktober 2013 di Pusat Jantung nasional Harapan Kita, Jakarta. Pasien dikelompokkan menjadi kelompok I (3 kali latihan seminggu) sebanyak 40 orang dan kelompok II (5 kali latihan seminggu) sebanyak 60 orang. Heart rate recovery satu menit diukur dengan uji jalan 6 menit/6 minute walk test (6MWT). Pengukuran dilakukan 2 kali, pada fase awal dan fase evaluasi setelah 12 kali. Peningkatan HRR dari kedua kelompok dianalisa dengan analisa regresi linier.Hasil:Pada studi kami, usia, gender, diabetes melitus, psikologis, merokok, bedah pintas arteri koroner dan lamanya aortic cross clamp setelah dianalisa tidak mempengaruhi peningkatan HRR secara bermakna. Frekuensi latihan 5 kali seminggu memberikan peningkatan HRR yang bermakna secara statistik dibandingkan 3 kali seminggu setelah dianalisa dengan regresi linier multivariate (RR 2,9; 95 % IK 1,53-4,40, p<0,001)Kesimpulan: Frekuensi latihan fisik 5 kali seminggu memberikan respon yang lebih baik terhadap peningkatan HRR dibandingkan latihan 5 kali seminggu."