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Abstrak :
Latar belakang: Modified Blalock-Taussig Shunt (MBTS) merupakan terapi paliatif untuk pasien dengan penyakit jantung bawaan (PJB) sianotik, namun memerlukan tatalaksana antikoagulan pascaoperasi agresif untuk mencegah komplikasi oklusi shunt dan perdarahan yang berujung pada kematian. Penelitian ini menilai efektivitas pemeriksaan koagulasi alternatif yaitu Activated Clotting Time (ACT) yang lebih mudah dan cepat dihasilkan dibandingkan dengan Activated Partial Thromboplastin Time (APTT) untuk regulasi antikoagulan yang lebih agresif untuk mencegah komplikasi pascaoperasi MBTS. Metode: Desain penelitian adalah retrospektif longitudinal. Semua pasien yang menjalani MBTS di periode Januari 2017 hingga Mei 2018 dibagi menjadi dua kelompok, yang menggunakan ACT setiap jam dan kelompok APTT yang diperiksa setiap empat jam. Kedua kelompok dievaluasi selama perawatan pascaoperasi adanya kejadian oklusi shunt, perdarahan, operasi ulangan, dan kematian Hasil: Total subjek adalah 174 pasien yang menjalani MBTS, sebanyak 59 pasien dilakukan regulasi heparin pascaoperasi dengan ACT dan 115 pasien dilakukan pemeriksaan APTT. Angka kejadian operasi ulangan lebih rendah signifikasn pada kelompok ACT dibandingkan APTT sebesar 6,77% (p= 0,023).Tidak terdapat perbedaan bermakna antara kedua kelompok pada kejadian oklusi (p=0,341; OR 0,571 IK95% 0,178-1,834), perdarahan pascaoperasi (p= 0,547; OR 0,563 IK95% 0,149-2,128), dan kematian (p=0,953; OR 0,975 IK95% 0,369-2,554). Kelompok ACT menunjukkan kecenderungan protektif terhadap kejadian-kejadian morbiditas pascaoperasi MBTS. Simpulan: Regulasi dosis heparin menggunakan pemeriksaan ACT nenurunkan kejadian operasi ulangan dan menunjukkan hasil protektif terhadap morbiditas pascaoperasi MBTS lainnya sehingga dapat dipertimbangkan penggunaannya. ...... Background: Modified Blalock-Taussig Shunt (MBTS) is a palliative treatment for cyanotic congenital heart disease (CHD) which needs postoperative anticoagulant treatment to prevent shunt occlusion and postoperative bleeding. This study was to find out the effectivity of alternative coagulation test of Activated Clotting time (ACT) which is faster and easier to produce compared to Activated Partial Thromboplastin Time (APTT) for a more aggressive anticoagulant regulation to prevent postoperative complcations. Methods: The study design is retrospective longitudinal study. All patients that underwent MBTS from January 2017 to Mei 2018 is deviden into 2 groups, first using ACT to regulate heparin and the second group using APTT. Both groups are studied for the incidence of shunt occlusion, bleeding, redo operation, and death. Results: Total subjects who underwent MBTS were 174 patients. Postoperative heparin is regulated using ACT in 59 patients and APTT in 115 patients. There are less shunt occlusion in ACT group (6,78%) compared to APTT (11,03%) but statistically insignificant (p = 0,341). Bleeding is less in ACT group (5,08%) compared to APTT (8,69%) but statistically insignificant (p= 0,547). Mortality is lower in ACT group (11,86%) compared to APTT (12,17%) but statistically insignificant (p = 0,953). Redo operation is significantly lower in ACT group (6,77%) compared to APTT (20%) with p = 0,023. Although statistically insignificant, ACT group showed clinically significant lower shunt occlusion, bleeding, and mortality. Conclusion: No significant difference between ACT and APTT in shunt occlusion, bleeding, and mortality, but redo operation is significantly lower in ACT group. ACT might be considered as alternative test for easier and faster method to regulate postoperative MBTS heparin dose.

Abstrak :
Latar belakang: Society of Thoracic Surgeons – European Association of Cardiothoracic Surgeons (STS-EACTS) mortality score dan category merupakan sistem stratifikasi risiko terbaru yang dikembangkan sebagai prediktor mortalitas dan morbiditas pascaoperasi penyakit jantung bawaan (PJB). Namun belum pernah divalidasi di Indonesia. Tujuan: Melakukan validasi eksternal STS-EACTS mortality score dan category pada populasi Indonesia. Metode: Uji validasi dengan studi potong lintang, menggunakan data dari Rumah Sakit Pusat Jantung Nasional Harapan Kita bagian bedah jantung anak dan kongenital dari Januari 2015 – Desember 2019. Nilai sensitivitas, spesifisitas, dan area under curve – receiving operator characteristic (AUC-ROC) menjadi luaran utama dalam menilai kemampuan prediksi mortalitas dan pemanjangan lama rawat pascoperasi (PLRP). Hasil: Penelitian melibatkan 4139 subjek dengan tingkat mortalitas 5,4% (230 subjek). STS-EACTS score memiliki sensitivitas dan spesifisitas sebesar 65% dan 68% dalam memprediksi mortalitas, dengan 62% dan 71% dalam memprediksi PLRP. STS-EACTS category memiliki sensitivitas dan spesifisitas sebesar 63% dan 68% dalam memprediksi mortalitas, dengan 61% dan 75% dalam memprediksi PLRP. STS-EACTS category memperlihatkan kemampuan diskriminasi yang baik untuk mortalitas dan PLRP (AUC-ROC 0,704 dan 0,701). Sementara pada mortality score hanya memberikan hasil cukup untuk PLRP (AUC-ROC 0,704 dan 0,679). Kesimpulan: STS-EACTS category merupakan prediktor yang baik dalam menilai luaran mortalitas dan PLRP pascaoperasi PJB. ...... Introduction: Society of Thoracic Surgeons – European Association of Cardiothoracic Surgeons (STS-EACTS) mortality score and category were the latest risk stratification for congenital heart disease (CHD) surgery, but it hasn't been validated in Indonesia. Aim: Validate STS-EACTS score and category in Indonesian population. Methods: Cross-sectional validation study was done using the dataset of Paediatric and Congenital Heart Surgery Department, National Cardiovascular Center Harapan Kita Indonesia, from January 2015 – December 2019. Sensitivity, specificity and area under curve – receiving operator characteristic (AUC-ROC) are used to assess its ability to predict mortality and PHLOS. Results: This study enrolled 4139 subjects with 5.4% mortality rate. The STS-EACTS score have the sensitivity and specificity of 65% and 68% to predict mortality, with 62% and 71% to predict PHLOS. The STS-EACTS category have the sensitivity and specificity of 63% and 68% to predict mortality, with 61% and 75% to predict PHLOS. The STS-EACTS category shows good discrimination ability in predicting mortality and PHLOS (AUC-ROC 0.704 and 0.701), whereas the mortality score only gives sufficient results in predicting PHLOS (AUC-ROC 0.704 and 0.697). Conclusions: The STS-EACTS category is a good predictor that can be used in Indonesian population to predict mortality and PHLOS following CHD surgery.

Abstrak :
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.

Abstrak :
Latar belakang: Sindrom curah jantung rendah (low cardiac output syndrome, LCOS) merupakan salah satu morbiditas yang terjadi pascaoperasi jantung terbuka. Angka kejadian LCOS pada pasien pascaoperasi sebanyak 25–65%, sehingga diperlukannya suatu penanda biologis praoperatif untuk menilai keadaan pembedahan yang optimal. NT-proBNP merupakan suatu biomarker yang berpotensi digunakan dalam diagnosis, tata laksana dan prognosis pada populasi pediatrik. Penelitian ini bertujuan untuk mengevaluasi peran NT-proBNP sebagai faktor prediktor terhadap kejadian LCOS pascabedah jantung terbuka. Metode: Studi longitudinal dilakukan di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita dalam periode November 2018 hingga Maret 2020 dengan merekrut subjek di bawah usia 18 tahun yang menjalani operasi korektif kelainan jantung bawaan. Kadar NT-proBNP prabedah diambil dan dianalisis terhadap kejadian LCOS pascaoperasi. Hasil: Terdapat 159 subjek dilibatkan sebagai subjek penelitian. Angka kejadian LCOS pascaoperasi sebanyak 23,9%. Median NT-proBNP prabedah berbeda bermakna antara pasien yang mengalami LCOS dengan pasien yang tidak mengalami LCOS (1592 pg/mL vs. 227 pg/mL; p = 0,001). Nilai cut-off NT-proBNP prabedah terhadap kejadian LCOS pascaoperasi adalah 400 pg/mL, dengan sensitivitas 78,95%, spesifisitas 64,46%, positive predictive value 41,10%, negative predictive value 90,70% dan diagnostic accuracy 67,92%. Simpulan: NT-proBNP prabedah dapat dijadikan faktor prediktor terhadap kejadian LCOS pascaoperasi jantung terbuka. Nilai cut-off NT-proBNP prabedah terhadap luaran LCOS pascaoperasi adalah 400 pg/mL. ...... Background: Low cardiac output syndrome (LCOS) is a common morbidity following open heart surgery in pediatric population. The incidence of postoperative LCOS range from 25 to 65%, indicating the needs for preoperative tool to evaluate optimum condition prior to surgery. NT-proBNP is a biomarker that has potential in diagnosis, management, and prognosis in pediatric population. This study aims to evaluate the role of NT-proBNP as predictive factor for LCOS following cardiac surgery. Methods: A longitudinal study was conducted in Harapan Kita National Heart Center between November 2018 and March 2020. We recruited subjects below 18 years old who underwent corrective cardiac surgery. NT-proBNP was obtained preoperatively and analyzed for postoperative LCOS. Results: A total of 159 subjects were enrolled. The incidence of postoperative LCOS was 23.9%. The median of preoperative NT-proBNP was found to be significantly higher in patients experiencing LCOS compared to that of patients without LCOS (1592 pg/mL vs. 227 pg/mL; p = 0.001). The cut-off value for preoperative NT-proBNP to determine postoperative LCOS was 400 pg/mL with sensitivity of 78.95%, specificity of 64.46%, positive predictive value of 41.10%, negative predictive value of 90.70% and diagnostic accuracy of 67.92%. Conclusions: Preoperative NT-proBNP can be used as predictor for postoperative LCOS following cardiac surgery. The cut-off value of preoperative NT-proBNP in determining postoperative LCOS was found to be 400 pg/mL.