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[ABSTRAK
Latar Belakang: Pada anak dengan penyakit jantung bawaan (PJB) yang menjalani operasi jantung terbuka, sepsis merupakan salah satu komplikasi pascaoperasi. Lama prosedur pintas jantung paru, usia, status gizi, timektomi, dan variasi genetik, seperti polimorfisme toll-like receptor (TLR) 2 dan tollinteracting protein (TOLLIP) dapat memengaruhi respons imun. Informasi mengenai peran faktor tersebut terhadap kejadian sepsis dan respons imun pascaoperasi jantung terbuka masih terbatas. Tujuan: Mengetahui peran polimorfisme TLR2, TOLLIP, dan faktor lainnya terhadap kejadian sepsis dan respons imun pascaoperasi jantung terbuka untuk memperoleh strategi paling tepat dalam penanganan kasus bedah jantung pada anak. Metodologi: Studi longitudinal dengan non-probability consecutive sampling dilakukan 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 yang mengekspresikan TLR2, dan sel NK. Pasien menjalani operasi jantung terbuka. Setelah operasi, pasien dimonitor untuk menilai sepsis dan respons imun pascaoperasi. Hasil: Dari 108 subjek yang terlibat, 21,3% diantaranya mengalami sepsis. Seluruh subjek adalah mutan TLR2 Arg677Trp, 92,6% pasien adalah mutan TLR2 N199N, dan 52,8% pasien adalah mutan TOLLIP rs5743867. Polimorfisme TLR2 N199N dan timektomi total tidak diikutkan dalam model analisis multivariat. Polimorfisme TOLLIP rs5743867 (p = 0,358) menurunkan resiko sepsis, lama prosedur pintas jantung paru ≥90 menit (p = 0,002), usia neonatus (p = 0,032), dan gizi buruk (p = 0,558) meningkatkan risiko sepsis pascaoperasi. Jumlah respons imun bervariasi antara kategori, namun secara umum komponen respons imun lebih rendah pada pasien yang mengalami sepsis dibanding pada pasien yang tidak mengalami sepsis. Simpulan: Lama prosedur pintas jantung paru dan usia neonatus secara signifikan memengaruhi risiko dan kecepatan sepsis pascaoperasi. Peran polimorfisme TLR2 N199N dan TOLLIP rs5743867 terhadap kejadian sepsis dan respons imun pascaoperasi memerlukan studi komprehensif lebih lanjut.

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ABSTRACT
Background: Sepsis is one of the complications in children with congenital heart defect 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 immune response. Information regarding those factors in the development of sepsis and immune response after open heart surgery is still limited. Objectives: To understand the role of TLR 2 and TOLLIP polymorphism, as well as other risk factors, in the development of sepsis and immune response following open heart surgery to develop the best strategy in open heart surgery in children. Methods: Longitudinal study with consecutive sampling were done in children <1 year old who underwent open heart surgery. Blood sample was obtained to check for TLR2 Arg677Trp polymorphism, TLR2 N199N polymorphism, TOLLIP rs5743867 polymorphism, the numbers of intracellular interferon γ CD4 and CD8, TLR2 expression in Dendritic cells, and NK cells. Patient then underwent open heart surgery. Thymectomy was done as indicated and CPB time was recorded. After surgery, patient was monitored for signs of sepsis and immune response was checked. Results: Out of 108 patients involved in this study, 21.3% developed postoperative sepsis. TLR2 Arg677Trp polymorphism was found in all patients, TLR2 N199N polymorphism was found in 92.6% of the patients, and TOLLIP rs5743867 polymorphism was found in 52.8% of the patients. TLR2 N199N polymorphism and thymectomy were not included in multivariate analysis. TOLLIP rs5743867 polymorphism (p = 0.358) reduced the risk of sepsis, CPB time ≥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 vary in each category, but were generally lower in patients who developed postoperative sepsis. Conclusion: Cardiopulmonary bypass time and neonates significantly influenced the risk and hazard of postoperative sepsis. Further investigation on the role of TLR2 N199N and TOLLIP rs5743867 polymorphism are necessary to provide more comprehensive explanation on the development of postoperative sepsis and the immune response after open heart surgery;Background: Sepsis is one of the complications in children with congenital heart defect 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 immune response. Information regarding those factors in the development of sepsis and immune response after open heart surgery is still limited. Objectives: To understand the role of TLR 2 and TOLLIP polymorphism, as well as other risk factors, in the development of sepsis and immune response following open heart surgery to develop the best strategy in open heart surgery in children. Methods: Longitudinal study with consecutive sampling were done in children <1 year old who underwent open heart surgery. Blood sample was obtained to check for TLR2 Arg677Trp polymorphism, TLR2 N199N polymorphism, TOLLIP rs5743867 polymorphism, the numbers of intracellular interferon γ CD4 and CD8, TLR2 expression in Dendritic cells, and NK cells. Patient then underwent open heart surgery. Thymectomy was done as indicated and CPB time was recorded. After surgery, patient was monitored for signs of sepsis and immune response was checked. Results: Out of 108 patients involved in this study, 21.3% developed postoperative sepsis. TLR2 Arg677Trp polymorphism was found in all patients, TLR2 N199N polymorphism was found in 92.6% of the patients, and TOLLIP rs5743867 polymorphism was found in 52.8% of the patients. TLR2 N199N polymorphism and thymectomy were not included in multivariate analysis. TOLLIP rs5743867 polymorphism (p = 0.358) reduced the risk of sepsis, CPB time ≥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 vary in each category, but were generally lower in patients who developed postoperative sepsis. Conclusion: Cardiopulmonary bypass time and neonates significantly influenced the risk and hazard of postoperative sepsis. Further investigation on the role of TLR2 N199N and TOLLIP rs5743867 polymorphism are necessary to provide more comprehensive explanation on the development of postoperative sepsis and the immune response after open heart surgery;Background: Sepsis is one of the complications in children with congenital heart defect 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 immune response. Information regarding those factors in the development of sepsis and immune response after open heart surgery is still limited. Objectives: To understand the role of TLR 2 and TOLLIP polymorphism, as well as other risk factors, in the development of sepsis and immune response following open heart surgery to develop the best strategy in open heart surgery in children. Methods: Longitudinal study with consecutive sampling were done in children <1 year old who underwent open heart surgery. Blood sample was obtained to check for TLR2 Arg677Trp polymorphism, TLR2 N199N polymorphism, TOLLIP rs5743867 polymorphism, the numbers of intracellular interferon γ CD4 and CD8, TLR2 expression in Dendritic cells, and NK cells. Patient then underwent open heart surgery. Thymectomy was done as indicated and CPB time was recorded. After surgery, patient was monitored for signs of sepsis and immune response was checked. Results: Out of 108 patients involved in this study, 21.3% developed postoperative sepsis. TLR2 Arg677Trp polymorphism was found in all patients, TLR2 N199N polymorphism was found in 92.6% of the patients, and TOLLIP rs5743867 polymorphism was found in 52.8% of the patients. TLR2 N199N polymorphism and thymectomy were not included in multivariate analysis. TOLLIP rs5743867 polymorphism (p = 0.358) reduced the risk of sepsis, CPB time ≥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 vary in each category, but were generally lower in patients who developed postoperative sepsis. Conclusion: Cardiopulmonary bypass time and neonates significantly influenced the risk and hazard of postoperative sepsis. Further investigation on the role of TLR2 N199N and TOLLIP rs5743867 polymorphism are necessary to provide more comprehensive explanation on the development of postoperative sepsis and the immune response after open heart surgery;Background: Sepsis is one of the complications in children with congenital heart defect 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 immune response. Information regarding those factors in the development of sepsis and immune response after open heart surgery is still limited. Objectives: To understand the role of TLR 2 and TOLLIP polymorphism, as well as other risk factors, in the development of sepsis and immune response following open heart surgery to develop the best strategy in open heart surgery in children. Methods: Longitudinal study with consecutive sampling were done in children <1 year old who underwent open heart surgery. Blood sample was obtained to check for TLR2 Arg677Trp polymorphism, TLR2 N199N polymorphism, TOLLIP rs5743867 polymorphism, the numbers of intracellular interferon γ CD4 and CD8, TLR2 expression in Dendritic cells, and NK cells. Patient then underwent open heart surgery. Thymectomy was done as indicated and CPB time was recorded. After surgery, patient was monitored for signs of sepsis and immune response was checked. Results: Out of 108 patients involved in this study, 21.3% developed postoperative sepsis. TLR2 Arg677Trp polymorphism was found in all patients, TLR2 N199N polymorphism was found in 92.6% of the patients, and TOLLIP rs5743867 polymorphism was found in 52.8% of the patients. TLR2 N199N polymorphism and thymectomy were not included in multivariate analysis. TOLLIP rs5743867 polymorphism (p = 0.358) reduced the risk of sepsis, CPB time ≥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 vary in each category, but were generally lower in patients who developed postoperative sepsis. Conclusion: Cardiopulmonary bypass time and neonates significantly influenced the risk and hazard of postoperative sepsis. Further investigation on the role of TLR2 N199N and TOLLIP rs5743867 polymorphism are necessary to provide more comprehensive explanation on the development of postoperative sepsis and the immune response after open heart surgery, Background: Sepsis is one of the complications in children with congenital heart defect 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 immune response. Information regarding those factors in the development of sepsis and immune response after open heart surgery is still limited. Objectives: To understand the role of TLR 2 and TOLLIP polymorphism, as well as other risk factors, in the development of sepsis and immune response following open heart surgery to develop the best strategy in open heart surgery in children. Methods: Longitudinal study with consecutive sampling were done in children <1 year old who underwent open heart surgery. Blood sample was obtained to check for TLR2 Arg677Trp polymorphism, TLR2 N199N polymorphism, TOLLIP rs5743867 polymorphism, the numbers of intracellular interferon γ CD4 and CD8, TLR2 expression in Dendritic cells, and NK cells. Patient then underwent open heart surgery. Thymectomy was done as indicated and CPB time was recorded. After surgery, patient was monitored for signs of sepsis and immune response was checked. Results: Out of 108 patients involved in this study, 21.3% developed postoperative sepsis. TLR2 Arg677Trp polymorphism was found in all patients, TLR2 N199N polymorphism was found in 92.6% of the patients, and TOLLIP rs5743867 polymorphism was found in 52.8% of the patients. TLR2 N199N polymorphism and thymectomy were not included in multivariate analysis. TOLLIP rs5743867 polymorphism (p = 0.358) reduced the risk of sepsis, CPB time ≥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 vary in each category, but were generally lower in patients who developed postoperative sepsis. Conclusion: Cardiopulmonary bypass time and neonates significantly influenced the risk and hazard of postoperative sepsis. Further investigation on the role of TLR2 N199N and TOLLIP rs5743867 polymorphism are necessary to provide more comprehensive explanation on the development of postoperative sepsis and the immune response after open heart surgery]

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ABSTRAK
Latar Belakang: Kecemasan praoperasi selalu menjadi perhatian bagi pasien maupun dokter anestesiologis dan dokter bedah. Pasien-pasien yang dihadapkan pada kenyataan harus menjalani operasi khususnya operasi jantung mungkin akan mengalami kecemasan yang lebih tinggi karena keadaan jantung mereka yang tidak baik, konsep operasi jantung yang menakutkan dan ketidakpastian terhadap hasilnya. Kecemasan akan mengaktifkan stres respon yang menyebabkan stimulasi sistem saraf simpatis yang kemudian akan menstimulasi kardiovaskular dengan meningkatkan jumlah katekolamin darah yang menyebabkan takikardi, hipertensi, iskemik dan infark miokardial. Respon tersebut mungkin mempunyai efek merugikan pada sirkulasi koroner, yang menyebabkan peningkatan morbiditas dan mortalitas. Berbagai penanganan telah dikembangkan, salah satunya adalah dengan pemberian informasi (edukasi). Dengan pemberian edukasi melalui komunikasi efektif, informatif dan empati diharapkan terjadi penurunan tingkat kecemasan pasien sebelum menjalani pembiusan dan pembedahan. Penelitian ini secara umum ingin mengetahui pengaruh edukasi pra-anestesia terhadap tingkat kecemasan pasien dewasa yang akan menjalani operasi jantung terbuka di Instalasi PJT RSUPN Cipto Mangunkusumo. Metode: Penelitian ini menggunakan uji kuasi eksperimen pada pasien dewasa yang akan menjalani operasi jantung terbuka di Instalasi PJT RSUPN Cipto Mangunkusumo. Setelah mendapatkan ijin komite medik dan informed consent, sebanyak 36 subyek didapatkan dengan consecutive sampling pada bulan Maret 2016. Sebelum dilakukan penilaian tingkat kecemasan sebelum edukasi dengan menggunakan instrumen APAIS, terlebih dahulu dilakukan pengukuran tanda vital, kemudian dilanjutkan dengan pemberian edukasi dan diskusi. Jika subyek tidak mengalami gaduh gelisah dan atau tanda bahaya kardiovaskular, maka keesokan hari sebelum subyek dibawa ke ruang operasi, akan dilakukan penilaian ulang tingkat kecemasan subyek dengan menggunakan instrumen yang sama. Hasil: Uji Wilcoxon menunjukkan terdapat penurunan bermakna rerata tingkat kecemasan sebelum edukasi dibandingkan dengan sesudah edukasi (p<0,001). Simpulan: Edukasi pra-anestesia menurunkan tingkat kecemasan pasien dewasa yang akan menjalani operasi jantung terbuka di Instalasi PJT RSUPN Cipto Mangunkusumo.

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ABSTRACT
Background: Preoperative anxiety is always a concern for patients, anesthetist and surgeon. Patients are faced with the reality had to undergo surgery, especially heart surgery may experience higher anxiety because their heart condition is not good, scary concept of heart surgery and uncertainty of the results. Anxiety will activate the stress response that causes stimulation of the sympathetic nervous system, which then stimulates the cardiovascular by increasing the amount of blood catecholamines that cause tachycardia, hypertension, ischemia and myocardial infarction. The response may have detrimental effects on the coronary circulation, which leads to increase morbidity and mortality. Various handling have been developed, one of which is the provision of information (education). With the provision of education through effective and informative communication with empathy are expected to decline the level of anxiety of patients before undergoing anesthesia and surgery. The objective of this study is to determine the effect of preanesthesia education to the level of anxiety in adult patients undergoing open heart surgery in the Installation of PJT Cipto Mangunkusumo. Methods: This study used a quasi-experimental trials of adult patients undergoing open heart surgery in the Installation of PJT Cipto Mangunkusumo . After getting permission from the medical committee and getting informed consent, a total of 36 subjects is obtained by consecutive sampling in March 2016. Prior to the assessment of the level of anxiety before education using APAIS instrument, first performed measurements of vital signs, and then continued with education and discussion. If the subject is not experiencing restless and rowdy or cardiovascular distress signal, then the next day before the subject is taken to the operating room, the level of anxiety of the subject will be reassessed using the same instrument. Results: Wilcoxon test showed that there was a significant decrease in the average level of anxiety before education compared with after education (p<0.001). Conclusion: Preanesthesia education lowers the level of anxiety in adult patients undergoing open heart surgery in the Installation of PJT Cipto Mangunkusumo.

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Latar Belakang : Fungsi Kognitif meliputi fungsi pemusatan perhatian, bahasa, daya ingat, motorik serta fungsi eksekutif fungsi perencanaan, pengorganisasian, pelaksannaan dan pemantauan . Postoperative Cognitive Dysfunction POCD didefinisikan sebagai gangguan fungsi kognitif yang baru muncul setelah prosedur pembedahan. POCD pascabedah jantung terbuka yang menggunakan teknologi pintas jantung paru CPB merupakan sekuele yang secara teoritis sering terjadi. Belum ada penelitian POCD serta faktor-faktor yang mempengaruhinya di Indonesia sehingga penelitian ini dirasakan perlu dilakukanTujuan : Mengetahui kekerapan terjadinya penurunan fungsi kognitif pada subjek yang menjalani bedah jantung terbuka di RSUPN Dr. Cipto Mangunkusumo serta faktor-faktor yang mempengaruhinya.Metode : Penelitian ini adalah penelitian kohort prospektif. Dilakukan penilaian fungsi kognitif terhadap 60 pasien yang menjalani operasi bedah jantung terbuka dengan menggunakan test neuropsikologik. Hasil data pra dan pascabedah akan dibandingkan. Fungsi kognitif dikatakan turun bila terdapat penurunan 20 pada salah satu alat uji. Kriteria penerimaan adalah usia >18 tahun yang menjalani operasi bedah jantung di RSUPN Dr. Cipto Mangunkusumo Jakarta, dapat berbahasa Indonesia, membaca dan menulis, bersedia menjadi subjek penelitian. Hasil penelitian diolah dengan uji bivariat dan analisis regresi logistic.Hasil : Penurunan fungsi kognitif terjadi pada 40,7 subjek yang menjalani operasi jantung terbuka dengan menggunakan teknologi pintas jantung-paru. Faktor usia merupakan faktor yang berpengaruh melalui analisis bivariat dan regresi logistik p 0,001 .Kesimpulan : Terjadi penurunan fungsi kognitif pada subjek yang menjalani bedah jantung terbuka di RSUPN Dr. Cipto Mangunkusumo yang dipengaruhi oleh usia, namun tidak dipengaruhi tingkat pendidikan, diabetes melitus, lama CPB dan klem silang.Kata Kunci : POCD, cardiopulmonary bypass, operasi bedah jantung terbuka

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Background Cognitive functions include the function of attention, language, memory, motoric and executive functions planning, organizing, and monitoring . Postoperative Cognitive Dysfunction POCD is defined as a cognitive dysfunction that arises after a surgical procedure. POCD after open heart surgery with cardiopulmonary bypass CPB is frequent theoretically. There was no research on POCD and the factors that influence it in Indonesia so that this research was necessary to be done.Purpose To know the frequency of POCD in subjects underwent open heart surgery at Dr. Cipto Mangunkusumo and the factors that influence it.Methods This study was a prospective cohort study. Cognitive function assessment was performed in 60 patients underwent open heart surgery by using neuropsychological tests. Pre and postoperative data were compared. Cognitive decline was defined if there was a 20 decrease in cognitive function in at least one of the tests. Inclusion criteria were age 18 years old who underwent open heart surgery at Dr. Cipto Mangunkusumo Jakarta, could speak Indonesian language, were able to read and write, and were willing to become the subject of the research. The result of this research was analyzed by bivariate test and logistic regression analysis.Results POCD occured in 40.7 of subjects who underwent open heart surgery using cardiopulmonary bypass. Age was the only influential factor through bivariate test and logistic regression analysis p 0.001 .Conclusion POCD occured in subjects who underwent open heart surgery at Dr. Cipto Mangunkusumo which was influenced by age, but not by education level, diabetes, CPB and cross clamp time.Keywords POCD, cardiopulmonary bypass, open heart surgery.

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Objektif: infark miokard perioperatif merupakan salah satu komplikasi pada CABG. Prediksi untuk terjadinya komplikasi tersebut dan deteksi dini pada fase paska operasi sangat penting dilakukan untuk menurunkan tingkat morbiditas dan mortalitas. Penelitian kaii ini dilakukan untuk mencari Faktor-faktor predisposisi terjadinya infark miokard perioperatif serta peran troponin T sebagai biomarker prediktor dan deteksi dini komplikasi tersebut. Metoda: empat puluh enam pasien yang akan menjalani CABG saja dan untuk pertama kali secara elektif diobservasi secara prospektif. Data faktor predisposisi, faktor intraoperasi dan paska operasi pada periode perioperatif dicatat. Diagnosis infark perioperatif ditegakkan berdasarkan EKG dan nilai CK-MB. Nilai troponin T diambil pada 24 jam preoperasi, 1 dan 6 jam setelah total revaskularisasi. Hasil : enam pasien (13%) teridentifikasi mengalami infark. perioperatif. Mortalitas terjadi pada 1 orang (2,1%) yaitu pada kelompok infark. Faktor preoperasi yang mempunyai hubungan bermakna untuk terjadinya infark adalah EuroSCORE dan angina tidak stabil. Pada fase intraoperasi, faktor yang teridentifikasi bermakna adalah konversi OPCAB ke on pump karena gangguan hernodinamik dan adanya gangguan hemodinamik signifikan preinsisi. Walaupun kurang bermakna, teknik CABG on pump memiliki prosentase infark yang lebih tinggi (19%) dibandingkan dengan teknik OPCAB (7%). Pada CABG on pump, penggunaan CPB, klem silang aorta, waktu iskemia lebih lama pada kelompok infark dan kardioplegia juga lebih sering diberikan. Morbiditas berupa penambahan lama waktu intubasi (p=0,009) dan lama penggunaan inotropik juga terjadi pada kelompok infark (61 jam) dibandingkan non infark (15 jam). Troponin T pada infark sudah berbeda secara bermakna 6 jam setelah revaskularisasi dengan nilai rerata 1 ng/ml (p=0,002). Nilai troponin T preoperatif juga sudah berbeda preoperasi antara kelompok infark dan non infark (0,01 vs 0,02 ng/ml) walaupun secara statistik kurang bermakna. Kenaikkan troponin T juga berkorelasi positif dengan lama pemakaian inatropik, lama intubasi, dan kadar CK-MB paska operasi. Kesimpulan: infark miokard perioperatif meningkatkan angka mortalitas dan morbiditas pada fase perioperatif. Empat faktor teridentifikasi sebagai faktor resiko. Trapanin T mampu mengidentifikasi terjadinya infark perioperatif 6 jam paska operasi dengan nilai 1 ng/ml. Terdapat kemungkinan untuk memprediksi resiko terjadinya infark perioperatif dengan pemeriksaan troponin T preaperasi apabila terjadi kenaikkan di alas 0,02 ng/ml.

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Pada operasi koreksi penyakit jantung bawaan PJB dengan teknik pintas jantung paru PJP , proses sindrom respons inflamasi sistemik SRIS sering menjadi penyulit pascaoperasi. Disfungsi mitokondria pada SRIS diawali dengan pelepasan mediator inflamasi TNF-. Dampak cedera neurologis pascabedah belum dapat dihindari. Biomarker Brain derived protein S100B dapat digunakan sebagai penanda hipoksia serebral akibat disfungsi mikrosirkulasi dan mitokondria pada operasi PJB. Pemantauan keadaan hipoksia serebral diperlukan karena kejadian awal defisit neurologis sering tidak menimbulkan manifestasi klinis. Near infrared spectroscopy NIRS merupakan salah satu alat yang dapat memantau penghantaran oksigen ke otak dengan mengukur saturasi oksigen serebral SctO 2 . Penelitian ini bertujuan untuk mengevaluasi peran S100B, sTNFR-1, laktat, saturasi vena cava superior dan saturasi oksigen serebral sebagai prediktor kejadian defisit neurologis pada operasi koreksi PJB. Penelitian ini bersifat kohort propsektif. Kriteria inklusi adalah pasien anak dengan PJB usia 1 bulan minus;6 tahun yang menjalani operasi koreksi. Kriteria eksklusi adalah pasien anak dengan sindrom Down, dengan arteri koroner tunggal, dan yang orang tuanya menolak berpartisipasi dalam penelitian. Dalam analisis, subjek dibagi menjadi 2 kelompok yakni kelompok 1 mengalami defisit neurologis dan kelompok 2 tidak mengalami defisit neurologis . Semua subjek dipantau selama perawatan di ICU, dan tetap diikuti sampai keluar rumah sakit. Pemeriksaan darah dilakukan dalam tiga kali pemantauan: pra-operasi, akhir PJP, dan 4 jam pasca-PJP. Monitoring NIRS dilakukan selama 24 jam pascabedah di ICU. Selama periode Maret 2015 minus;Oktober 2015, didapatkan 51 pasien yang diteliti. Terdapat perbedaan proporsi yang bermakna antara konsentrasi S100B, sTNFR-1, laktat, dan NIRS AUC 20 baseline saturasi serebral pasien PJB pascabedah koreksi dengan PJP pada kelompok berdasarkan defisit neurologis. Parameter tersebut dapat dipakai sebagai model prediktor kejadian defisit neurologis pascabedah jantung dengan PJP. Nilai S100B, sTNFR-1, laktat, dan nilai NIRS AUC 20 dari baseline saturasi serebral dapat digunakan sebagai prediktor kejadian defisit neurologis pascabedah pada operasi PJB dengan mesin PJP.

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In congenital heart disease CHD surgery using cardiopulmonary bypass CPB machine, systemic inflammation response syndrome SIRS process often causes post-operation complication. Mitochondria dysfunction in SRIS starts with the release of inflammation mediator TNF-? and sTNFR-1. Neurological injury after pediatric congenital heart surgery still cannot be avoided. Study about brain derived protein S100B as a biomarker for cerebral hypoxia caused by microcirculation and mitochondria disfunction as SRIS consequence in PJP in pediatric CHD surgery has yet to be conducted. Observation to find cerebral hypoxia is needed because the early stages of cerebral hypoxia often not show any symptoms. NIRS is one of the tools for observing oxygen delivery to the brain by measuring the cerebral oxygen saturation SctO 2 . In Indonesia, NIRS is still not common to be used and there are no studies about it yet. This study aimed to evaluate the role of S100B, sTNFR-1, lactate, saturation of superior vena cava and cerebral saturation as the predictor of neurological deficiency incidence on correction of CHD. This was a prospective cohort research. Inclusion criteria were children with CHD aged 1 month minus;6 years old who underwent corrective operation. Exclusion criterias were children with Down syndrome, with single coronary artery, and whose parents declined to participate in this study. In analysis, subjects were divided into 2 groups; group 1 with neurological deficit and group 2 without neurological deficit. All subjects were observed closely while they were in ICU, observed until they discharge from hospital. Blood examination were done 3 times: before surgery, after CPB, and 4 hours after CPB. Monitoring of NIRS was done during 24 hours after surgery in ICU. During March minus;October 2015, there were 51 patients included. There are significant difference for value of S100B, STNFR-1, lactate, and NIRS AUC 20 baseline of cerebral saturation between groups based on neurological deficit occurrence. Those parameters could be used as predictor of neurologic deficiency incidence post operation using CPB in CHD children. In CHD patients who underwent corrective operation with CPB, S100B value, sTNFR1, lactate, and AUC 20 baseline of cerebral saturation could be used as predictor of neurologic deficit after corrective operation.

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Latar Belakang : Model prediksi risiko mortalitas dan morbiditas pascapembedahan jantung digunakan untuk penjelasan kepada pasien mengenai risikoperioperasi, pemilihan tatalaksana, perbandingan hasil pascaoperasi dan alokasidana oleh penjamin kesehatan nasional. Husink dkk mengembangkan suatu sistemskor prediksi mortalitas dan morbiditas pasca pembedahan katup jantung yaitu skorHarapan Kita pada tahun 2015. Sistem skor model prediksi mortalitas memilikidaya kalibrasi dan diskriminasi yang baik sedangkan model prediksi morbiditasmemiliki daya kalibrasi baik dan daya diskriminasi sedang. Sampai saat ini belumada validasi eksternal pada sistem skor Harapan Kita tersebut, sehingga perludilakukan untuk dapat selanjutnya diimplementasikan secara klinis. Tujuan : Memvalidasi secara eksternal sistem skor Harapan Kita sebagai prediktormortalitas dan morbiditas di rumah sakit pasien yang menjalani pembedahan katupjantung. Metode : Penelitian merupakan studi potong lintang dengan metode validasieksternal temporal yang dilakukan di Departemen Kardiologi dan KedokteranVaskular Universitas Indonesia/Rumah Sakit Jantung dan Pembuluh DarahHarapan Kita, menggunakan data sekunder Januari 2015 hingga September 2016,yang diambil secara total sampling. Analisis data ditujukan untuk mendapatkannilai kalibrasi dan diskriminasi. Hasil : Sampel akhir berjumlah 789, kejadian mortalitas di rumah sakit 8.6 68dari 789 sampel dan prediksi mortalitas dengan skor Harapan Kita 11.9 .Kejadian morbiditas di rumah sakit 34.7 dan prediksi morbiditas dengan skorHarapan Kita 19.1 . Setelah dilakukan penghitungan skor Harapan Kita padasemua sampel studi, didapatkan nilai kalibrasi prediksi mortalitas p = 0.169 dandiskriminasi/AUC sebesar 0,761 95 IK; 0.702-0.821 sedangkan prediktormorbiditas kalibrasi p = 0.689 dan AUC 0.753 95 IK; 0.716-0.789. Kesimpulan : Sistem skor Harapan Kita secara eksternal valid untuk memprediksimortalitas dan morbiditas pasien yang menjalani pembedahan katup jantung. ...... Background: Mortality and morbidity risk prediction model after cardiac surgeryis used to explain perioperative risk, choice of treatment, comparation of surgeryresults, and for financial allocation consideration by national health insurance.Harapan Kita score was developed in 2015. This scoring system had a goodcalibration and discrimination for predicting mortality also a good calibration butmoderate discrimination for predicting morbidity. However this score never beenexternally validated. Objective: To validate externally the Harapan Kita scoring system as an inhospitalmortality and morbidity predictor in patients who is undergoing valvular heartsurgery. Methods: This is a cross sectional study with temporal external validation methodthat performed at the Department of Cardiology and Vascular Medicine,Universitas Indonesia National Cardiovascular Center Harapan Kita, usingsecondary data from January 2015 until September 2016, which taken by totalsampling method. Data analysis is intended to develop the calibration anddiscrimination level. Results: The final samples were 789, with 8.6 68 from 789 samples mortalityevent and a mortality predictor of Harapan Kita Score 11.9. The Odds Ratio OR of all variables were similar with the OR of Harapan Kita score previous study. Callibration value for mortality predictor were p 0.169 with a discrimination AUC 0.761 95 CI 0.702 0.821 meanwhile calibration value formorbidity predictor were p 0.689 and AUC 0.753 95 CI 0.716 0.789. Conclusion: Harapan Kita scoring system valid externally to predict in hospitalmortality and morbidity in patients undergoing valvular heart surgery

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Latar belakang: Sepsis pascabedah jantung terbuka merupakan kondisi yang jarang terjadi tetapi memiliki mortalitas yang cukup tinggi. Gejala sepsis yang muncul pascabedah seringkali sulit dibedakan dengan kondisi inflamasi sistemik sehingga menimbulkan keterlambatan dalam menegakkan diagnosis maupun overtreatment pada pasien. Presepsin merupakan salah satu penanda sepsis yang mulai banyak digunakan terutama pada populasi dewasa. Penelitian ini bertujuan untuk melihat peran presepsin dalam menegakkan diagnosis sepsis pascabedah jantung terbuka pada anak. Tujuan: Untuk menguji performa diagnostik presepsin sebagai penanda sepsis pada anak pascabedahjantung terbuka dibandingkan dengan prokalsitonin (PCT). Metode: Studi potong lintang terhadap 49 pasien anak pascabedah jantung terbuka yang dirawat di RSCM. Penelitian ini mencari nilai batas optimal presepsin untuk mendiagnosis sepsis pascabedah jantung terbuka pada anak yaitu pada hari pertama dan ketiga pascabedah, kemudian membandingkannya dengan prokalsitonin. Analisis kurva ROC dikerjakan untuk menentukan nilai batas optimal presepsin. Hasil: Kadar presepsin hari pertama (T1) dan ketiga (T3) lebih tinggi pada subyek dengan sepsis daripada subyek yang tidak sepsis (median 415 pg/mL vs. 141,5 pg/mL pada hari pertama dan 624 pg/mL vs. 75,9 pg/mL pada hari ke tiga). Titik potong presepsin pada T1 dengan nilai 404 pg/mL memiliki performa untuk mendiagnosis sepsis dengan AUC 0,752 sedangkan presepsin T3 dengan nilai 203,5 pg/mL dengan AUC 0,945 yang lebih baik dibandingkan T1. Simpulan: Presepsin dapat dijadikan suatu modalitas untuk memberikan nilai tambah dan pertimbangan bagi klinisi untuk menegakkan diagnosis sepsis pada pasien anak pascabedah jantung terbuka. ......Background: Postoperative open-heart sepsis is a rare condition but has a fairly high mortality. Symptoms of sepsis that appear postoperatively are often difficult to distinguish from systemic inflammatory conditions, causing delays in establishing diagnosis and overtreatment in patients. Presepsin is one of the markers of sepsis that is starting to be widely used, especially in the adult population. This study is to identify the role of presepsin for diagnosing sepsis in post open-heart surgery in pediatric population. Aim: To perform diagnostic test of presepsin as sepsis screening markers compares to procalcitonin (PCT) in post open-heart surgery. Methods: Cross-sectional study of 49 postoperative open-heart pediatric patients treated at RSCM. This study looked for optimal cut-off values of presepsin for diagnosing open-heart postoperative sepsis in children on the first and third postoperative days, then compared it with procalcitonin. ROC curve analysis is performed to determine the optimal limit value of presepsin. Result: First (T1) and third day (T3) PSP levels were higher in subjects with sepsis than non- sepsis (median 415 pg/mL vs. 141.5 pg/mL on first day and 624 pg/mL vs. 75.9 pg/mL on third day). ). T1 presepsin cut off 404 pg/ml had AUC of 0.772, while T3 presepsin cut off 203.5 og/ml had better AUC of 0.945. T3 is better for diagnosing sepsis. Conclusion: Presepsin can be used as a modality to provide added value and consideration for clinicians to establish the diagnosis of sepsis in pediatric patients after open-heart surgery.

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Latar belakang: Penyakit jantung bawaan merupakan jenis kelainan bawaan lahir paling umum, dan merupakan penyebab kematian tersering pada bayi. Sindrom curah jantung rendah masih merupakan masalah yang dihadapi pada subjek pediatrik pascaoperasi jantung terbuka. Deteksi sindrom curah jantung rendah dengan kriteria klinis dan indikator laboratorik masih dirasa belum cukup, yang terbukti dengan masih adanya angka morbiditas dan mortalitas. Peranan penanda biologis NT-proBNP diharapkan dapat digunakan untuk dapat mendeteksi sindrom curah jantung rendah pada pediatrik. Metode: Penelitian pendahuluan kohort retrospektif dengan jumlah 47 subjek yang memenuhi kriteria inklusi dan eksklusi yang menjalani pembedahan jantung terbuka paliatif; PA banding, Bidirectional cavopulmonary shunt, BT-shuntdan Fontan, pada periode Oktober 2019 hingga Maret 2020 di Rumah Sakit Jantung dan Pembuluh darah Nasional Harapan Kita, Indonesia. Data prabedah, intrabedah dan pascaoperasi termasuk kejadian sindrom curah jantung rendah dicatat. Kadar NT-proBNP akan diambil prabedah, 4 jam, 24 jam dan 72 jam pascaoperasi. Analisis data menggunakan uji Mann-Whitney. Hasil: Kadar NT-proBNP pada prosedur palitif khususnya Fontan pada prabedah (137 pg/ml), 4 jam pascaoperasi (685 pg/ml), 24 jam pascaoperasi (5.715 pg/ml), dan 72 jam pascaoperasi (970 pg/ml). Kadar NT-proBNP prabedah, 4 jam pascaoperasi, 24 jam pascaoperasi, dan 72 jam pascaoperasi tidak berbeda bermakna dengan kejadian sindrom curah jantung rendah (nilai p >0,05). Kesimpulan: Ditemukan peningkatan nilai NT-Pro BNP pada subjek pascaoperasi jantung paliatif khususnya Fontan dan bidirectional cavopulmonary shunt yang mengalami sindrom curah jantung rendah pada jam ke-24. Namun kesimpulan diatas masih berdasarkan jumlah sampel dengan kekuatan penelitian <80% sehingga hanya berlaku sebagai kesimpulan sementara berdasarkan studi pendahuluan. ...... Background: Congenital heart disease is the most common type of birth defects, and is the most common cause of death in infants. Cardiac syndrome is still a problem faced by pediatric patients after heart surgery. Detection of Low Cardiac Output Syndrome with clinical criteria and laboratory indicators is still considered insufficient, which is proven to still contain morbidity and mortality rates. The role of NT-proBNP biological markers is expected to be used to support the detection of low cardiac output syndrome in pediatrics. Methods: A Preliminary retrospective cohort with 47 subjects fulfilling the inclusion and exclusion criteria who underwent palliative open heart surgery PA banding, Bidirectional cavopulmonary shunt, BT-shunt and Fontan from October, 2019 to March, 2020 at the Harapan Kita National Heart and Vascular Hospital, Indonesia. Preoperative, operative and postoperative data including the incidence of low cardiac output syndrome were recorded. NT-proBNP levels will be taken pre-surgery, 4 hours, 24 hours and 72 hours after surgery. Data analysis using the Mann-Whitney test. Results: NT-proBNP levels in the cardiac palliative surgery especially Fontan procedure at pre-surgery (137 pg/mL), 4 hours after surgery (685 pg/mL), 24 hours after surgery (5,715 pg/mL), and 72 hours after surgery (970 pg/mL). NT-proBNP levels at pre-surgery, 4 hours after surgery, 24 hours after surgery, and 72 hours after surgery were not significantly different from the incidence of low cardiac output syndrome (p value> 0.05). Conclusion: There is an increase in NT-Pro BNP values ​​in subjects with Fontan palliative heart surgery and bidirectional cavopulmonary shunt. However, the above conclusions are still based on the number of samples with research powers<80% and can only be taken as a provisional conclusion based on preliminary studies.