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"Transposition of Great Arteries (TGA) adalah kelainan penyakit jantung bawaan sianotik kedua yang paling sering ditemukan. Tatalaksana definitif saat ini adalah Arterial Switch Operation (ASO). Angka mortalitas pasca ASO di negara maju cukup rendah, sementara di negara berkembang sekitar 15%. Pada TGA Intact Ventricular Septum (TGA IVS), sebaiknya ASO dilakukan ≤ 3 minggu. Sedangkan, di negara berkembang, karena berbagai hal multifaktorial, ASO sering dilakukan saat usia > 3 minggu. Pengaruh usia saat operasi > 3 minggu terhadap kelangsungan hidup jangka panjang sampai saat ini masih kontroversial. Penelitian ini bertujuan untuk mengetahui pengaruh usia saat operasi > 3 minggu terhadap kelangsungan hidup 10 tahun pasien TGA yang menjalani operasi ASO. Penelitian ini merupakan studi kohort retrospekstif yang dilakukan pada pasien TGA IVS yang keluar hidup setelah operasi ASO selama periode Januari 2008-Desember 2018. Pasien kemudian dilakukan follow up untuk mengetahui kondisi hidup dan meninggal. Analisis waktu terjadinya event ditentukan berdasarkan titik awal dan titik akhir penelitian. 71,9 % pasien menjalani operasi ASO > 3 minggu. Angka kelangsungan hidup 10 tahun keseluruhan pasien pasca operasi Arterial Switch Operation sebesar 90%. Walaupun mean survival time kelompok usia operasi ≤ 3 minggu lebih panjang dibandingkan dengan kelompok usia operasi > 3 minggu (113 bulan vs 107 bulan), tetapi secara statistik tidak berbeda bermakna. Usia saat operasi > 3 minggu mempunyai risiko meningkatkan risiko kematian sebesar HR 0,49 (IK95% 0,11-2,27; p=0.86).

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Transposition of Great Arteries (TGA) is the second most common found cyanotic congenital heart disease. The current definitive management is Arterial Switch Operation (ASO). Early and long term mortality rates after ASO in developed countries are quite low, while in developing countries the number is around 15%. In TGA Intact Ventricular Septum (TGA IVS), ASO should be done in ≤ 3 weeks. However, in developing countries, due to various multifactorial causes, it is often being done at the age of > 3 weeks. The effect of age at surgery > 3 weeks on long-term survival is still controversial. This study aims to determine the effect of age at surgery and other factors on the 10-year survival of patients after ASO. A retrospective cohort study was done on TGA IVS patients that survived ASO surgery during the period of January 2008-December 2018. Patients were being followed up to find out if they are still alive. Analysis of the time to evaluate the event is determined based on the starting point and end point of the study. 71,9% patients underwent ASO surgery > 3 weeks. The overall 10-year survival rate of patients after Arterial Switch Operation is 90%. Even though the mean survival time of the operating age group ≤ 3 weeks is longer than the operation age group > 3 weeks (113 months vs 107 months), but it is not statistically significant. Age at surgery > 3 weeks had a risk of increasing the risk of death by HR 0,49 (IK95% 0,11-2,27; p=0.86).

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"Penyakit Jantung Bawaaan (PJB) Tetralogy of Fallot (TOF) merupakan PJB sianotik (biru) terbanyak. Tatalaksana definitif operasi sedini mungkin. Hampir semua pembiayaan menggunakan BPJS Kesehatan berdasarkan tarif INA-CBG. Adanya selisih negatif tarif INA-CBG tahun 2016 dengan tagihan perawatan operasi TOF menyebabkan banyak rumah sakit tidak mengoperasi dan merujuk ke RSJPD Harapan Kita. Dengan adanya tarif INA-CBG terbaru tahun 2023 yang mengalami kenaikan, diperlukan penelitian apakah terdapat selisih negatif. Perlu dianalisa faktor yang berhubungan dengan tagihan perawatan serta kepatuhan Clinical Pathway (CP) TOF. Penelitian observasional deskriptif cross sectional mengambil sampel pasien perawatan operasi total koreksi TOF tahun 2022 sejumlah 82 pasien. Hasil penelitian didapatkan sebagian besar usia ≥1 tahun, perempuan, status gizi normal, ada diagnosa sekunder, severitas PPK I (ringan) dan INA-CBG II (sedang), tidak ada komplikasi, kelas III, median lama CPB 103,5 menit dan AoX 55 menit, lama rawat post operasi 6 hari dan total 8 hari. Faktor yang berhubungan dengan tagihan perawatan adalah komplikasi, kelas rawat dan lama rawat CP. Hal yang belum sesuai dengan CP TOF yaitu lama rawat, pemeriksaan laboratorium, radiologi, pemakaian obat, alkes dan BMHP. Masih terdapat selisih negatif antara total tagihan perawatan pasien operasi total koreksi TOF tahun 2022 dengan total tarif INA-CBG terbaru tahun 2023.

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Tetralogy of Fallot (TOF) is the most common cyanotic Congenital Heart Disease (CHD). Definitive management is surgery earliest as possible. Almost all financing uses BPJS Kesehatan based on INA-CBG rate. Negative difference between the 2016 INA-CBG rates and TOF surgery treatment bill make many hospitals not operating and refering to Harapan Kita Hospital. With increasing in the latest 2023 INA-CBG rates, research for negative difference is needed. Analyzing factors related to care bills and adherence to TOF Clinical Pathway (CP) is studied too. This cross-sectional descriptive observational study took a sample of 82 patients undergoing TOF total  correction in 2022. Results showed that most were aged ≥1 year, female, normal nutritional status, had secondary diagnoses, severity of PPK I (mild) and INA-CBG II (moderate), no complications, class III, median duration of CPB 103.5 minutes and AoX 55 minutes, length of postoperative care 6 days and total of 8 days. Factors related to treatment bills are complications, class of care and CP length of care. Things not in accordance with the TOF CP are length of stay, laboratory, radiology, drug, medical equipment and BMHP use. There is still negative difference between the 2022 TOF total correction treatment patient bills and the latest 2023 INA-CBG rate."

"Konsekuensi hemodinamik defek septum atrium sekundum (DSAS) salah satunya adalah hipertensi arterial pulmonal (HAP), yang merupakan prediktor morbiditas dan mortalitas pascaoperasi. Indeks resistensi vaskular paru (IRVP) merupakan salah satu parameter operabilitas DSAS-HAP. Nilai IRVP < 4 WU.m2(IRVP rendah) dikatakan aman untuk dilakukan penutupan, sedangkan IRVP 4 WU.m2(borderline) berada di area abu-abu dimana mungkin sudah terjadi penyakit vaskular paru. Belum terdapat studi yang membandingkan luaran klinis pasca operasi kedua kelompok IRVP. Penelitian ini bertujuan untuk mengetahui hubungan IRVP preoperasi terhadap mortalitas dan morbiditas perioperatif pascaoperasi DSAS-HAP. Studi kohort retrospektif dilakukan pada pasien DSAS-HAP usia 18 tahun yang menjalani operasi penutupan defek. Analisis akhir dilakukan pada 183 pasien (92 kelompok IRVP borderline dan 91 kelompok IRVP rendah). Mayoritas berjenis kelamin perempuan (83,6%) dengan median usia 37 (18-64) tahun. Median IRVP preoperasi adalah 4,3 (0,4-13,5) WU.m2. Nilai IRVP borderline tidak meningkatkan risiko mortalitas pascaoperasi (p = 0,621; OR 0,48, 95% IK 0,04-5,48), namun meningkatkan risiko morbiditas keseluruhan (p= 0,002;  OR 3,28, 95% IK 1,5-6,72). Analisis multivariat memperlihatkan hubungan IRVP borderline (p=0,045; OR 2,63, 95% IK 1,02-6,77) dan tricuspid valve gradient (TVG) preoperasi 64 mmHg (p=0,034; OR 2,77, 95% IK 1,08-7,13) dengan kejadian morbiditas intraperawatan. Tidak terdapat perbedaan kejadian mortalitas pascaoperasi intraperawatan antara pasien IRVP borderline preoperasi dengan IRVP rendah. Nilai IRVP borderline preoperasi dan TVG berkaitan dengan peningkatan morbiditas intraperawatan.

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One of hemodynamic consequences of secundum atriap septal defect (ASD) is pulmonary arterial hypertension (HAP), which is a predictor of postoperative morbidity and mortality. Pulmonary vascular resistance index (PVRI) is one of operability parameter for SASD with HAP. Pulmonary vascular resistance index < 4 WU.m2(low PVRI) is said to be safe for closure, while PVRI 4 WU.m2(borderline) is in the gray zone where pulmonary vascular disease may have occurred. Studies comparing clinical outcomes of these PVRI group in secundum ASD with HAP do not yet available. This study aims to determine the impact of preoperative PVRI on perioperative morbidity and mortality after surgical closure of secundum ASD with HAP. This study is a retrospective cohort study in secudum ASD with HAP patients age 18 years old undergoing surgical closure. A total of 183 patients were analyzed (92 borderline PVRI group and 91 low PVRI group). Majority of patient is female (83,6%) with median age 37 (18-64) years old. Median preoperative PVRI is 4,3 (0,4-13,5) WU.m2. Borderline PVRI was not associated with increase risk of postoperative mortality (p = 0,621; OR 0,48, 95% CI 0,04-5,48),but increase the risk of overall morbidity in bivariate analysis (p= 0,002;  OR 3,28, 95% CI 1,5-6,72). Multivariate analysis showed the association of PVRI borderline (p=0,045; OR 2,63, 95% CI 1,02-6,77) and preoperative tricuspid valve gradient (TVG) 64 mmHg (p=0,034; OR 2,77, 95% CI 1,08-7,13) with overall morbidity. There was no difference in the incidence of inhospital mortality between preoperative borderline PVRI patients compared to low PVRI patients. Preoperative borderline PVRI and TVG are associated with increase inhospital morbidity."

"Latar Belakang : Terdapat dua modalitas terapi paliatif pada populasi pasien penyakit jantung bawaan biru pulmonary duct dependent yaitu intervensi kateterisasi dengan PDA stent dan pembedahan dengan mBTT shunt. Sampai saat ini belum ada penelitian yang membandingkan luaran kedua tindakan paliatif ini pada usia yang lebih tua.Tujuan: Mengetahui luaran tindakan PDA stent dibandingkan dengan mBTT shunt sebagai terapi paliatif pada pasien penyakit jantung bawaan sianotik dengan pulmonary duct dependent.Metode : Dilakukan studi kohort retrospektif menggunakan data sekunder terhadap 143 pasien yang menjalani terapi paliatif PDA stent dan mBTT shunt pada periode Agustus 2016 sampai Agustus 2022 di RS Pusat Jantung Harapan Kita. Dilakukan pemantauan selama perawatan hingga 30 hari pasca tindakan. Hasil: Total 143 pasien yang dimasukkan ke dalam analisis luaran primer dan sekunder; 43 pasien menjalani PDA stent dan 100 pasien menjalani mBTT shunt dengan median usia kelompok PDA stent 110 (31-1498) hari dan kelompok mBTTshunt 174.5 (30-1651) hari. Komposit luaran primer tidak bermakna pada kedua kelompok meliputi mortalitas 30 hari (6(14%) vs 14 (14%), p=1,000), reintervensi (1(2,3%) vs 7 (7%),p = 0,436) , dan rehospitalisasi 30 hari (0(0%) vs 2(2%),p=0,319). Analisis luaran sekunder didapatkan angka lama rawat inap ICU lebih pendek pada kelompok PDA stent(2 (0-16) hari vs 4 (1-63) hari, p =0,002).Kesimpulan: PDA stent memiliki luaran yang tidak berbeda dengan tindakan mBTT shunt pada komposit luaran meliputi mortalitas 30 hari, reintervensi, dan rehospitalisasi 30 hari namun berbeda bermakna pada lama rawat ICU.

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Background: There are two modalities of palliative therapy in the population of patient with pulmonary duct dependent which is catheterization intervention with PDA stent and surgery with BTT shunt. To date, there have been no studies that have compared the outcomes of these two palliative strategy in older age.

Objectives: To determine the outcome of PDA stent compared to mBTT shunt as palliative therapy in patients with pulmonary duct dependent congenital heart disease.

Methods: A retrospective cohort study was conducted using secondary data on 143 patients undergoing palliative therapy for PDA stents and mBTT shunts from August 2016 to August 2022 at National Cardiovascular Center Harapan Kita. Monitoring was carried out during treatment up to 30 days after the procedure.

Results : A total of 143 patients were included in the primary and secondary outcome analysis; 43 patients underwent PDA stent and 100 patients underwent mBTT shunt with median age of PDA stent group 110 (31-1498) days and mBTT shunt group 174.5 (30-1651) days. Primary outcome composite was not significant in both groups including 30 days mortality (6(14%) vs 14(14%), p=1.000), reintervention (1(2.3%) vs 7(7%),p=0.436) , and 30 days rehospitalization (0(0%) vs 2(2%),p=0.319). Secondary outcome analysis showed shorter ICU length of stay in the PDA stent group (2 (0-16) days vs 4 (1-63) days, p = 0.002).

Conclusion: PDA stent has an outcome that is not different from the mBTT shunt procedure in the composite outcome including 30 days mortality, reintervention, and 30 days rehospitalization but significantly different in ICU length of stay."

"Latar belakang: Arterial Switch Operation (ASO) merupakan prosedur utama pada Transposition Intact Ventricular Septum (TGA-IVS). TGA-IVS kehadiran terlambat (usia ≥30 hari) mempengaruhi kesintasan pascaprosedur ASO dan umum ditemukan di negara berkembang, termasuk Indonesia. Semakin besar usia pada populasi penyakit jantung kongenital, terutama TGA-IVS, umumnya disertai status gizi kurang. Hubungan antara status gizi terhadap kesintasan pascaprosedur ASO pada TGA-IVS kehadiran terlambat belum diketahui Metodologi: Penelitian studi potong lintang berdasarkan data sekunder dari rekam medis pada pasien TGA-IVS≥ 30 hari yang menjalani operasi ASO periode 2015-2021.Variabel utama yang dinilai adalah status gizi berdasarkan kurva status gizi WHO 2006 Variabel yang ikut dinilai antara lain usia, jenis kelamin, anomali koroner, pola anomali, jenis ASO, lama penggunaan mesin jantung paru, dan penggunaan klem silang aorta terhadap mortalitas pascaprosedur ASO. Hasil: Terdapat 89 anak dengan kehadiran terlambat; 68,53% memiliki status gizi kurang/buruk. Karakteristik pasien TGA-IVS kehadiran terlambat adalah laki-laki (67,2-67,9%), tidak memiliki anomali koroner dan memiliki pola anomali koroner normal (67,2-78,6%) dan menjalani ASO primer (67,9-68,9%). Status gizi kurang/buruk tidak memiliki hubungan terhadap risiko kemation pascaprosedur ASO (OR: 2,41, P:0,661) dibandingkan status gizi cukup. Lama mesin jantung paru merupakan prediktor mortalitas independen (p = 0,031) Kesimpulan: Status gizi rendah tidak memilki hubungan terhadap mortalitas pascaprosedur ASO pada TGA-IVS kehadiran terlambat.

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Background: Arterial Switch Operation (ASO) is the main procedure for Transposition of with Intact Ventricular Septum (TGA-IVS). Late presenter TGA-IVS (age ≥30 days) has lower postoperative ASO survival and commonly found in developing country, including Indonesia. Older age in congenital heart disease, including TGA-IVS, associated with poor nutritional status. The correlation between nutritional status and mortality post ASO in late presenter TGA-IVS remains unknown. Method: a cross sectional study based on secondary data based on medical record of late presenter TGA-IVS who undergoned ASO in 2015-202. The main measured variable is nutritional status based on WHO 2006 nutritional status curves. Other measured variables are age at intervention, gender, coronary anomaly, coronary patterns, ASO types, cardiopulmonary bypass time, aortic crosss-clamp time and hospital mortality post ASO Result: 89 children identified as late presenter TGA-IVS; 68,53% with poor nutritional status. The late presenter TGA-IVS characteristics are male (67,2-67,9%), normal coronary anatomy and pattern (67,2-78,6%), and mostly underwent primary ASO (67,9-68,9%). Poor nutritional status has no correlation (OR: 2,41, P:0,661) with mortality outcome post ASO if compared with normal nutritional status. CPB time is an independent risk factor for mortality (p = 0,031). Conclusion: No correlation between poor nutritional status with mortality outcomes post ASO procedure in late presenter TGA-IVS"

"Latar belakang: Modified Blalock-Taussig shunt (MBTS) merupakan prosedur bedah jantung sederhana namun memiliki angka mortalitas cukup tinggi. Karakteristik terutama usia pasien yang menjalani prosedur MBTS di Indonesia berbeda dengan negara lain.Tujuan: Membandingkan angka mortalitas operatif MBTS berdasarkan kriteria usia dan  mengidentifikasi faktor prediktor mortalitas operatif dan morbiditas pascaoperasi MBTS.Metode: Penelitian ini merupakan studi kohort retrospektif mortalitas pada 400 pasien yang menjalani operasi MBTS di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita.Hasil: Mortalitas berdasarkan kriteria usia yaitu 32,1% pada usia ≤ 28 hari, 19,9% pada usia 29-365 hari, 3,6% pada usia 366-1825 hari dan 8% pada usia > 1825 hari. Berat badan kurang dari 3 kg, kadar hematokrit lebih dari 45% sebelum operasi dan kadar activated partial thromboplastine time (aPTT) < 60 detik sebagai prediktor mortalitas. Transfusi packed red cell  (PRC) > 6 ml/kg, penggunaan ventilasi mekanik dan penggunaan prostaglandin preoperasi dan kadar aPTT < 60 detik 4 jam pasca operasi terbukti sebagai prediktor morbiditas.Kesimpulan: Terdapat perbedaan bermakna angka mortalitas pascaoperasi berdasarkan usia. Kriteria usia tidak terbukti sebagai prediktor mortalitas. Berat badan < 3 kg meningkatkan mortalitas. Prediktor morbiditas pascaoperasi adalah transfusi PRC > 6ml/kg, penggunaan ventilator, penggunaan prostaglandin dan kadar aPTT < 60 detik.

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Background: Modified Blalock-Taussig shunt (MBTS) is a simple procedure but has a considerable operative mortality rate. Patient’s characteristics who underwent MBTS in Indonesia is different than other country. There was no predictor of operative mortality has been identified in Indonesian.

Objectives: To compare mortality rate based on age criteria and to identify mortality and morbidity predictors after MBTS procedure.

Methods: A retrospectively cohort study was conducted on 400 patients who underwent MBTS at National cardiovascular center Harapan Kita (NCCHK).

Results: There were 32,1% death at age ≤ 28 days, 19,9% at age 29-365 days, 3,6% at age 366-1825 days and 8% at age > 1825 days. Body weight < 3 kg, haematocrite level > 45% before procedure and activated partial thromboplastine time level (aPTT) < 60 seconds were operative mortality  predictors. Packed red cell  transfusion (PRC) > 6 ml/kg, mechanical ventilator and prostaglandin E1 use before procedure, aPTT level < 60 seconds after procedure were identified as postoperative morbidity predictors.

Conclusion: age was not proven as an operative mortality predictors. Body weight < 3 kg increase mortality rate. Postoperative morbidity predictors were PRC transfusion > 6ml/kg, aPTT level < 60 seconds, mechanical ventilator and prostaglandine E1 use."