Hasil Pencarian

Ditemukan 2 dokumen yang sesuai dengan query

Ismail

Luaran Penggunaan Strip Tunggal Perikardium dan Katup Mekanik dalam Penggantian Katup Aorta: Kajian terhadap Left Ventricle Reverse Remodeling, Six Minute Walking Test dan Soluble Suppression of Tumorigenicity-2 = Outcome of Single-Strip Pericardium and Mechanical Valve in Aortic Valve Replacement: Study on Left Ventricle Reverse Remodeling, Six Minute Walking Test and Soluble Suppression of Tumorigenicity-2

"Penggantian katup aorta dengan katup mekanik memerlukan biaya mahal, meningkatkan risiko endokarditis dan tromboemboli, serta memerlukan antikoagulan seumur hidup. Perikardium autolog merupakan alternatif untuk penggantian katup aorta. Tujuan penelitian ini adalah membandingkan luaran penggantian katup aorta antara katup mekanik dan perikardium autolog dengan teknik strip tunggal perikardium. Penelitian ini merupakan uji klinis terandomisasi di Pelayanan Jantung Terpadu Rumah Sakit Cipto Mangunkusumo (PJT-RSCM). Subjek dibagi ke dalam 2 kelompok berdasarkan jenis katup yang diterima, yaitu katup mekanik (kelompok mekanik) dan strip perikardium (kelompok strip). Luaran left ventricular reverse remodeling (LVRR), 6 minute walking test (6MWT), dan kadar soluble suppression of tumorigenicity-2 (sST-2) diperiksa preoperasi, 3 bulan, dan 6 bulan pascabedah. Terdapat 34 subjek yang ikut serta dari Juli 2016-Februari 2022, 17 subjek pada masing-masing kelompok. Tidak terdapat beda kejadian LVRR pada kedua kelompok, yaitu 26,7% pada kelompok mekanik dan 29,4% pada kelompok strip (p = 0,703). Pada pemeriksaan jarak 6 minute walking test (6MWT) tidak terdapat perbedaan bermakna jarak 6MWT antara kelompok strip perikardium dan kelompok mekanik pada 6 bulan pascabedah, yaitu 431,93 (SB 93,41) m vs. 404,28 (SB 79,25) m, p = 0,427 pascabedah. Kadar sST-2 kelompok mekanik 16,12 (SB 5,92) pg/mL secara bermakna lebih tinggi dibandingkan kelompok strip 11,52 (SB 6,96) pg/mL, p = 0,023) pada 6 bulan pascabedah. Disimpulkan teknik strip tunggal perikardium memiliki luaran yang sebanding dengan katup mekanik sehingga dapat digunakan sebagai alternatif penggantian katup aorta.

Aortic valve replacement with mechanical valves are quite expensive, increased the risk of adverse events such as endocarditis and thromboembolism, and requires patients to take anticoagulants for the rest of their life. Autologous pericardium is an alternative for aortic valve replacement. This study aims to compare outcomes of aortic valve replacement using mechanical valve and prosthetic valve with single-strip pericardium technique. This was a randomized clinical trial conducted at the Cipto Mangunkusumo Hospital (PJT-RSCM). Eligible subjects were randomized to either receive mechanical valve (mechanical group) or single-strip pericardium (single-strip group). Outcome assessments of left ventricular reverse remodeling (LVRR), 6 minute walking test (6MWT), and soluble suppression of tumorogenicity-2 (sST-2) were carried out at preoperation, 3 months, and 6 months postoperation. There were 34 subjects recruited from July 2016 to February 2022, 17 subjects in each groups. There was no difference in postoperative LVRR incidence between both groups, 26.7% in mechanical group vs. 29.4% in single strip group (p = 0.703). There was no significant difference of 6MWT between the mechanical and pericardial strip at six months post-operation, 404.28 (SD 79.25) m vs. 431.93 (SD 93.41) m, p = 0.427. The sST-2 level is significantly higher in mechanical group 16.12 (SD 5.92) pg/mL compared to single strip group 11.52 (SD 6.96) pg/mL, p = 0.023 at six months post-operation. We concluded that single strip pericardium technique showed comparable outcomes to mechanical valve and is considered a feasible alternative for aortic valve replacement."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2022

D-pdf

UI - Disertasi Membership Universitas Indonesia Library

Dicky Fakhri

Peran polimorfisme toll like receptor 2 dan toll interacting protein terhadap kejadian sepsis dan respons imun pada anak di bawah 1 tahun yang menjalani operasi jantung terbuka = Role of toll like receptor 2 and toll interacting protein polymorphism in the development of sepsis and immunology response in children less than 1 year old undergoing open heart surgery

"[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.

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