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"Latar Belakang: Oklusi total kronik (OKT) adalah salah satu lesi paling sulit untuk ditangani dalam intervensi koroner perkutan (IKP). Menurut studi, kesintasan pasien yang telah melalui IKP bergantung kepada beberapa faktor resiko. Tujuan penelitian ini adalah untuk mengetahui faktor-faktor yang mempengaruhi kesintasan pasien OKT yang telah melalui IKP. Metode: Riset ini menggunakan desain penelitian kohort retrospektif dengan kriteria sampel pasien OKT yang telah dilakukan tindakan IKP di Rumah Sakit Umum Pendidikan Nasional Dr, Cipto Mangunkusumo sejak tahun 2017 sampai 2019. Observasi melalui analisis Kaplan-meier dan cox regression dilakukan untuk menentukan kesintasan satu tahun. Hasil: Terdapat 204 sampel yang telah dikumpulkan dalam studi ini. Kesintasan satu tahun yang didapatkan adalah 88,2%, dengan mayoritas kematian terjadi di bulan pertama. Rata-rata pasien merupakan 58,46 + 11,06 ciri ciri pasien lebih banyak di kelompok umur <60 tahun (62,7%) dan laki-laki (87,7%). Rasio hazard menunjukkan pasien OKT setelah IKP lebih beresiko untuk kematian bila merupakan laki-laki, lebih tua dari 60 tahun, memiliki komorbiditas diabetes dan penyakit ginjal kronis, dan memiliki lesi di LAD, LCX dan RCA. Sedangkan pasien yang memiliki hipertensi dan dislipidemia lebih tidak berisiko untuk kematian. Kesimpulan: Pasien OKT setelah IKP memiliki kesintasan 88,2% setelah satu tahun, fator resiko yang ditemukan tidak signifikan secara statistik untuk menentukan faktor resiko kematian.

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Background: Chronic total occlusion (CTO) lesion is considered one of the most technically challenging intervention in percutaneous coronary intervention (PCI). The survival of patients who have undergone the procedure varies among research and is affected by several risk factors. This research aims to determine the risk factors and 1 year survival of CTO patients post-PCI. Method: This research uses a retrospective cohort study design with samples of CTO patients that had undergone PCI at Dr. Cipto Mangunkusumo Hospital between 2017 to 2019. The one-year survival of the patients was observed through Kaplan-Meier analysis and cox regression. Result: From 204 samples included in this study, the one-year survival was 88.2%, with the majority of death occuring in the first month. The mean age of the patients was 58.46 + 11.06, with more patients in the <60 age group (62.7%) and males (87.7%). The hazard ratio shows that CTO patients were more likely to experience mortality after PCI when they were older than 60 years old, males, had diabetes, CKD, occlusion on the LAD, LCX and RCA. In contrast, patients were less likely of death when they had hypertension and dyslipidemia. Conclusion: CTO patients that had undergone PCI had a survival rate of 88.2% after one year, and risk factors were statistically insignificant in determining risk factors leading to mortality."

"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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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."

"[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: EuroSCORE II (European System for Cardiac Operative Risk Evaluation) banyak digunakan sebagai model prediksi resiko mortalitas intrahospital dan juga mulai diteliti sebagai prediktor kesintasan jangka panjang untuk operasi jantung. Namun penggunaannya pada pembedahan katup jantung memilki nilai uji validasi yang buruk. TAPSE (Tricuspid Annular Plane Systolic Excursion), sebagai salah satu parameter fungsi ventrikel kanan diketahui menjadi salah satu prediktor pasien yang menjalani pembedahan jantung.Tujuan: Mengetahui perbandingan kemampuan prediksi mortalitas intrahospital dan kesintasan jangka panjang antara EuroSCORE II dengan kombinasi EuroSCORE II dan TAPSE (EuroSCOREII+TAPSE) dan kombinasi modifikasi variabel EuroSCORE II+TAPSE (Modified Euro-TAPSE-Score) pasien yang menjalani pembedahan katup jantung.Metode: Dilakukan studi kohort retrospektif terhadap 1842 pasien yang menjalani pembedahan katup jantung pada periode 2018-2021. Analisis bivariat dan multivariat antara nilai EuroSCORE II, variabel EuroSCORE II, dan TAPSE untuk mortalitas intrahospital dan kesintasan 4,5 tahun. Uji validasi dilakukan terhadap semua model prediksi resiko.Hasil: Mortalitas intrahospital yang diobservasi adalah 9,0 % dan untuk mortalitas jangka panjang adalah 18,8%. Sebagai prediktor mortalitas intrahospital, Modified Euro-TAPSE Score dan EuroSCOREII+TAPSE memilki nilai uji validasi yang lebih baik [(AUC 0,730; uji H-L p:0,988) vs (AUC 0,681; uji H-L p:0,065)] dibandingkan EuroSCORE II saja (AUC 0,686; uji H-L p:0,028). EuroSCORE II secara signifikan berhubungan dengan kesintasan jangka panjang (p<0,0001), namun TAPSE tidak dapat digunakan sebagai prediktor (p: 0,643) sehingga modifikasi EuroSCORE II dengan TAPSE tidak dapat dilakukan.Kesimpulan: Modified Euro-TAPSE-Score dan EuroSCOREII+TAPSE memiliki nilai prognostik yang lebih baik dibandingkan EuroSCORE II untuk mortalitas intrahospital pasien yang menjalani pembedahan katup jantung.

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Background: EuroSCORE II (European System for Cardiac Operative Risk Evaluation) is widely used as a risk predictive model for intrahospital mortality and has been studied as a predictor of long-term survival for cardiac surgery. However, its use in valvular heart surgery (VHS) has poor validation test values. TAPSE (Tricuspid Annular Plane Systolic Excursion), as a parameter of right ventricular function is known to be one of the predictors of patients undergoing cardiac surgery

Objective: To compare the predictive ability of intrahospital mortality and long-term survival between EuroSCORE II with EuroSCORE II and TAPSE combination (EuroSCOREII+TAPSE) and EuroSCORE II variable modification with TAPSE (Modified Euro-TAPSE-Score) in patients undergoing VHS.

Metds: A retrospective cohort study was conducted on 1842 patients undergoing VHS in 2018-2021 period. Bivariate and multivariate analyzes of EuroSCORE II, EuroSCORE II variables, and TAPSE for intrahospital mortality and 4,5 year survival. Validation tests were carried out on all risk prediction models.

Results: The observed intrahospital mortality was 9,0% and long-term mortality was 18,8%. As predictors of intrahospital mortality, Modified Euro-TAPSE Score and EuroSCOREII+TAPSE have better validation test values [(AUC 0,,730; H-L test p:0,988) vs (AUC 0,681; H-L test p:0,065)] compared to EuroSCORE II (AUC 0,686; H-L test p:0,028). EuroSCORE II was significantly associated with long-term survival (p<0.0001), but TAPSE could not be used as a predictor (p:0,643) so EuroSCORE II modification with TAPSE could not be performed.

Conclusion: Modified Euro-TAPSE-Score and EuroSCOREII+TAPSE have a better prognostic value than EuroSCORE II for intrahospital mortality in patients undergoing VHS."

"Tujuan: Menilai pengaruh pernn khusus pintas jantung pore (PR) pada metabolisme laktat pasta bedah pintas koroner (BPK)Tempat: Unit Tempi Inlensif Rumah Sakit Jantung Harapan Kita, Jakarta, Indonesia.Subyek Penelitian: 40 pasien BPK dengun PJP (BPK-PJP), 20 pasien off pump coronary artery bypass (OPCAB) (n=20), dan 20 pasien yang akan menjalani BPK.Intervensi dan pengukuran: telaah metabolisme laktat dilakukan dengan uji infus natrium laktat (2,5 mmol Natrium laktat 11.2 %/kg BB dalam waktu 15 menit) pada kelompok BPK-PJP(n=20), OPCAB, dan kelompok Pra bedah. Sebagai kontrol pada BPK-PJP(n=20) di-infus natrium klorida 6%(Ionisitns sama dengan natrium laktat 11,2%, 2,5 mmol Natrium klorida dalam waktu 15 menit). Laktat darah arteri diperiksa pada semua kelompok; pada waktu (t) -15, 0, 5, 10, 20, 30, 60, 90, dan 120 menit sesudah infus berakhir. Pada kelompok BPK-PJP laktat darah juga diperiksa pada saat yang bersamaan dari 2 tempat lain yaitu a. pulmonalis dan v. femoralis sehingga dapat dihitung gradien luktat dari otot skelet dan paru-paru. Analisis gas darah ateri dan a. pulmonulis diperiksa sebelum dan sesudah akhir infus pada kelompok BPK-PJP dan OPCAB,dan kemudian dengan termodilusi diukur curah jantung sehingga dapat dihitung indeks kardiak, hantaran oksigen, konsumsi oksigen, rasio ekstraksi oksigen sebelum dan sesudah akhir infus Natrium laktat dan Natrium klorida. Natrium dan glukosa diperiksa pada t-15, t0, dan t120 menit sesudah akhir infus. Bersihan laktat dun produksi laklat endogen tubuh dihitung dari area di buwah kurva (area under the curve) dengan piranti lunak khusus (Kaleidagrrph ®).Kesesuaian bieksponensial memungkinkan untuk membuat model penurunan kurva laktat dalam dua kompartemen (oksidasi laklat di luar hati dan daur ulang laktat),sehingga dengan piranti lunak yang lama dihitung dua waktu paruh (WP1 dan WP1) yang masing-masing merepresentasikan kedua jalur metabolisme laklat tersebut.Hasil: sesudah uji infus natrium laklat tidak terdapat perbedaan yang bermakna dari parameter metabolisme laktat (laktat basal, bersihan laktat. produksi laktat endogen, WP1 dan WP2) antara OPCAB dan pra-bedah. Tidak terdapat perbedaan yang bermakna pada laktat basal dan produksi laklat endogen antara BPK-PJP dengan Prabedah, tetapi pada BM-HP bersihan laktat menurun, WP1 memendek bermakna (p<0,05) dan WP2 (p<0,05) memanjang bermakna. Natrium laklat dan natrium klorida meningkatkan indeks kardiak dan hantaran oksigcn. Tidak terdapat perbedaan yang bermakna pada kenaikan indeks kardiak antara kedua kelompok tersebut, tetapi kenaikan hantaran oksigen akibat natrium laktat (29 ,6%) lebih tinggi bermakna (p<0,001) dibandingkan kenaikan hantaran oksigen akibat natrium klorida (15,13%). Tidak terdapat perbedaan yang bermakna antara pengaruh natrium laktat dan natrium klorida pada konsumsi oksigen dan ekstraksi oksigcn.Infus natrium laktat menyebabkan peningkatan pH yang bermakna (p<0,0001) dan infus natrium klorida menyebabkan penurunan pH yang bermakna (p<0,0005). Bikarbonat meningkat bermakna (p<0,05) pada kelompok pasien yang diinfus natrium laktat dan menurun bermakna pada kelompok pasien yang dinfus natrium klorida. Tidak ditemukan korelasi yang bermakna antara gradien luktat di paru-paru dan a. pulmonalis dan antara gradien otot skelet dan laktat arteri pada BPK-PJP.Kesimpulan: Bersihan laktat pada kelompok BPK-PJP yang mengalami perlakuan uji infus natrium laktat menurun bermakna. Di lain pihak tidak terdapat perbedaan yang bermakna pada parameter metabolisme laktat antara kelompok OPCAB dan Prabedah yang diteliti.Waktu paruh 2 memanjang bermakna, sehingga dengan memperhatikan penelitian terdahulu dapat disimpulkan bahwa: pintas jantung paru dapat mcnyebabkan disfungsi hati (gangguan metabolisme laktat di hati) meskipun dilakukan pada bedah jantung berisiko rendah dan tidak mengalami komplikasi.Natrium laktat meningkatkan hantaran oksigen lebih baik daripada natrium klorida dan berlawanan dengan natrium klorida. pH darah akibat infus nalrium laktat meningkat bermakna.

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Objective: To evaluate the effects of the specific rule of cardiopulmonary bypass (CPH) on lactate metabolism after coronary artery bypass grilling (CABG).

Setting: Intensive Care Unit. National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.

Subjects: Coronary artery bypass grating patients with CPB (n=40) off pump coronary artery bypass (OPCAB) (n=20) and patients who would undergo CABG (n-2020).

Interventions and Measurements: lactate metabolism was investigated by an exogenous lactate challenge lest (ELCT. 2.5 mmol Na-lactate 11,2% /kg body weight in 15 minutes) in the groups of CABG-CPB, OPCAB and Pre surgery. The control group of CABG-CPB (n 20) was investigable with Na-chloride (2,5 mmol Na-chloride 6 % with identical tonicity in 15 minutes). Arterial blood lactate was determined in all groups: T (time)-15. 0.5, 10, 20, 30,60, 90, and 1211 minutes after completion of infusion.

In the group of CABG-CPB blood lactate was examined simultaneously at two other sites. i.e. pulmonary artery and femoral vein such 1l1:11 the gradient of Wide from skeletal muscles and the lungs could be calculated. Blood gas analysis of artery end pulmonary artery was examined before and after infusion in the groups of CABG-CPB. and OPCAB and cardiac output was measured using thermodilution method such that cardiac index, oxygen delivery oxygen consumption, oxygen extraction ratio before and alter infusion of Na-lactate and Na-chloride could be determined. Sodium and glucose were examined at T-I5, 0, and 120 minutes alter completion of infusion. The area under the curve was determined from blood lactate allowing the calculation of lactate clearence and endogenous production. Moreover a hi-exponential titling permitted the modeling of the lactate decay into two compartments (lactate oxidation outside the liver and lactate recycling). Thus, two half-lives (HL1 and HL2) could be calculated using the same software well of which represents both pathways of lactate metabolism.

Results: There was no significant difference after ELCT from the parameters of lactate metabolism (basal tactile, lactate clearance, endogenous production, HL1, and HL2,) between OPCAB and Pre-surgery. No significant difference was found in basal Instate and endogenous production between CABG-CPB and Pre-surgery. However, Instate clearance and HL1 significantly decreased (p< 0.05), while HL2, increased (p<0.05).

Infusion of sodium lactate and sodium chloride increased cardiac index and oxygen delivery. No significant difference was found in the increase of cardiac index between the two groups: however, the increase of oxygen delivery due to sodium lactate (29±2.6%) was significantly higher (p<0.001) than the increase of oxygen delivery due to sodium chloride (15±3.5%). There was no significant difference between the effect of sodium lactate and sodium chloride on oxygen consumption and oxygen extraction ratio.

Infusion of sodium lactate resulted in the significant increase of pH (p< 0,0001) and infusion of sodium chloride resulted in the significant decrease of pH (p<0,0005). Bicarbonate increased significantly (p