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"Latar Belakang. Fibrilasi atrium (AF) adalah komplikasi aritmia yang paling sering ditemukan pada pasien yang menjalani operasi bedah pintas arteri koroner (BPAK) dengan insidens yang bervariasi antara 20-50%. Walaupun diketahui sebagai gangguan yang bersifat sementara, namun AF pasca operasi dapat mengancam jiwa serta dikaitkan juga dengan peningkatan angka kesakitan dan kematian yang bermakna, sehingga perlu diketahui faktor-faktor yang dapat menjadi prediktor terhadap kejadian AF pasca BPAK. Penelitian ini menilai interval elektromekanikal atrium yang diukur dengan menggunakan ekokardiografi Doppler jaringan dan dispersi interval elektromekanikal sebagai prediktor kejadian AF pasca BPAK. Metode. Seratus delapan pasien diambil secara konsekutif untuk studi potong lintang ini, mulai bulan Mei hingga September 2012 dari pasien penyakit jantung koroner yang menjalani operasi BPAK di Pusat Jantung Nasional Harapan Kita, Jakarta. Pasien menjalani pemeriksaan ekokardiografi sebelum operasi BPAK. Dilakukan penilaian terhadap interval elektromekanikal dengan Doppler jaringan pada lateral atrium kiri serta dispersi interval interatrial. Pasien dimonitor selama perawatan terhadap kejadian AF.Hasil. Dalam studi kami, 27 dari 108 (25%) pasien mengalami AF pasca operasi BPAK. Dari analisa terlihat perbedaan interval elektromekanikal di atrium kiri sebesar 18.04 ms dan terdapat perbedaan dispersi interval interatrial 10.25 ms antara kelompok pasien yang mengalami AF pasca BPAK dan yang tidak mengalami AF. Dari hasil analisa didapatkan nilai titik potong interval elektromekanikal di lateral atrium kiri sebesar 77,75 ms dan dispersi interval elektromekanikal sebesar 38,95 ms sebagai prediktor terhadap kejadian AF pasca BPAK.Kesimpulan. Interval elektromekanikal pada lateral atrium kiri dan dispersi interval interatrial dengan menggunakan Doppler jaringan merupakan potensial prediktor terhadap kejadian AF pasca BPAK.

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Background. Atrial fibrillation (AF) is the most common arrhythmia complication in patient undergone coronary artery bypass grafting (CABG) with the incidence of 20- 50% according to different studies. Although this complication is temporary but can be life threathening, and increased the number of mortality and morbidity. Thus, it is very important to identified factors that can predict the occurance of AF post CABG. This study use atrial electromechanical interval and interval dispertion measured by tissue Doppler echocardiography as predictor of AF post CABG.

Methods. One hundred and eight patients were included in this cross sectional study. Samples were taken consecutively from May to September 2012 among patients with coronary artery disease undergoing CABG at the National Cardiovascular Center Harapan Kita Jakarta. The patients underwent a preoperative transthoracic echocardiography with tissue Doppler evaluation. We measured the atrial electromechanical interval in the lateral of left atrium and interatrial interval dispertion. Patients was monitored thorugh out hospitalization for the occurance of AF.

Result. In our study, 27 out of 108 (25%) patients developed AF post CABG. There are 18.04 ms electromechanical interval difference in the lateral of left atrium and 10.25 ms interatrial dispersion difference between patients who suffer from post operative AF and non AF. From this study we have 77,75 ms as the cutoff point for interval electromechanical in the left atrium and 38.95 ms as the cutoff point for dispersion of interatrial interval as the predictor for AF post CABG.

Conclusion. The interval of Electromechanical in the lateral left atrium and interatrial interval dispersion using tissue dopper echocardiography are potensial predictor the occurrence of AF post CABG."

"Latar Belakang. Fibrilasi atrium (FA) awitan dini pascabedah pintas arteri koroner (BPAK) merupakan salah satu komplikasi pascaoperasi yang sering terjadi. Aritmia ini merupakan fenomena sementara dan mayoritas pasien akan mengalami konversi ke irama sinus saat dipulangkan. Meskipun bersifat sementara, FA awitan baru pasca-BPAK berpotensi mengalami rekurensi sehingga dapat meningkatkan risiko mortalitas jangka panjang.Tujuan. Mengetahui peran FA awitan baru pasca-BPAK dalam mempengaruhi kesintasan tiga tahun.Metode. Studi dengan desain kohort retrospektif menggunakan analisis kesintasan yang meneliti 196 pasien yang menjalani BPAK di Rumah Sakit Cipto Mangunkusumo dalam rentang waktu Januari 2012 sampai Desember 2015. Eksklusi dilakukan pada pasien yang memiliki riwayat FA sebelum operasi, menjalani operasi tanpa mesin pintas jantung-paru, dan yang meninggal dalam 30 hari pascaoperasi. Subyek penelitian dibagi menjadi 2 kelompok berdasarkan ada tidaknya FA awitan baru pasca-BPAK, yang selanjutnya ditelusuri status kematiannya dalam tiga tahun sejak operasi. Kurva Kaplan-Meier digunakan untuk menilai kesintasan tiga tahun dan dilakukan uji regresi Cox sebagai uji multivariat terhadap variabel perancu (usia ≥60 tahun, penyakit paru obstruktif kronis, diabetes melitus, gangguan ginjal, dan fraksi ejeksi ventrikel kiri yang rendah) untuk mendapatkan nilai adjusted hazard ratio (HR).Hasil. Sebanyak 29,59% pasien mengalami FA awitan baru pasca-BPAK. Angka mortalitas tiga tahun pasien yang mengalami FA awitan baru pasca-BPAK baru lebih tinggi dibandingkan kelompok yang tidak mengalaminya (15,52% vs 3,62%). Fibrilasi atrium awitan baru pasca-BPAK secara signifikan menurunkan kesintasan tiga tahun (p=0,008; HR. Pada analisis multivariat, FA awitan dini pascaBPAK merupakan faktor independen terhadap penurunan kesintasan tiga tahun (adjusted HR 4,04; IK 95% 1,34-12,14).Simpulan. Fibrilasi atrium awitan baru pasca-BPAK secara independen menurunkan kesintasan tiga tahun.

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Background. New-onset atrial fibrillation after coronary artery bypass grafting (CABG) is a common postoperative complication. This arrhytmia considered as temporary phenomenon which the majority are converted back to sinus rhythm when the patients discharged from the hospital. Despite its transience, those arrhythmia can recur and increasing the long term mortality.

Objective. To determine the role of new-onset atrial fibrillation after CABG on three year survival.

Method. This is a retrospective cohort study using survival analysis of patients who underwent coronary artery bypass grafting since January 2012 to December 2015 at Cipto Mangunkusumo Hospital. Patients who had atrial fibrillation before surgery, who had surgery without cardiopulmonary bypass machine, and who died in 30 days after surgery were excluded. Subjects were divided into two category based of the presence of newonset atrial fibrillation after CABG and the mortality status was followed up until 3 years post-surgery. The Kaplan-Meier curve was used to determine the three-year survival of the patients who had new-onset atrial fibrillation after CABG and Cox regression test used as multivariate analysis with confounding variables in order to get adjusted hazard ratio (HR).

Result. New-onset atrial fibrillation after CABG occurred in 29,59% patients. Patients with new-onset atrial fibrillation after CABG had higher three-year mortality (15,52% vs 3,62%). New-onset atrial fibrillation after CABG significantly decreased three-year survival (p=0,008; HR 4,42; 95% CI; 1,49-13,2). In multivariate analysis, it was concluded that new-onset atrial fibrillation after CABG was an independent factor of the three-year survival decline (adjusted HR 4,04; 95% CI; 1,34-12,14).

Conclusion. New-onset atrial fibrillation after CABG independently decreased the threeyear survival."

"Latar Belakang: Cedera reperfusi akibat dilepaskannya reactive oxygen species(ROS) saat penggunaan Cardiopulmonary bypass(CPB) dan kembalinya mengalir darah yang kaya oksigen pada miokard yang iskemia, dapat menyebabkan kerusakan miokard. Allopurinol sebagai penghambat xanthine oksidase, telah diteliti sebelumnya mengenai efektivitas dalam mengurangi cedera reperfusi pada bedah jantung terbuka yang belum menunjukkan hasil yang konklusif, meskipun pada beberapa penelitian memberikan hasil yang cukup baik pada pemulihan dari stunningmiokard, biomarker cedera reperfusi maupun kejadian atrial fibrilasi pascabedah (AFPB). Metilprednisolon juga dipakai untuk mengurangi efek inflamasi dan cedera reperfusi pada pasien bedah jantung terbuka karena perannya dalam menghambat secara indirek pengaktifan enzim NADPH oksidase.Tujuan penelitianini adalah untuk membandingkan efektifitas pemberian allopurinol peroral 600 mg pada malam hari dan 1 jam sebelum pembedahan dengan metilprednisolon intravena 15 mg/kgbb saat induksi anestesi dalam mengurangi cedera reperfusi pada bedah pintas arteri koroner.Metode: Telah dilakukan penelitian uji klinis acak tersamar ganda pada 42 pasien yang menjalani bedah pintas arteri koroner menggunakan CPB antara bulan Oktober 2019 hingga Maret 2020, yang dialokasikan ke dalam kelompok allopurinol atau kelompok metilprednisolon.Pemeriksaan biomarker cedera reperfusi dilakukan dengan pemeriksaan sampel darah malondialdehyde(MDA) yang dilakukan sesaat setelah pemasangan kateter vena sentral (basal) dan 5 menit setelah klem jepit aorta dilepas (pascareperfusi). Pemeriksaan MDA dilakukan dengan metode ELISA. Penilaian skor inotropik dan vasoaktif (SIV) dilakukan pada 24 jam pertama perawatan pascabedah. Sedangkan penilaian kejadian atrial fibrilasi pascabedah dilakukan selama 48 jam pertama pascabedah. Data yang diperoleh dianalisis dengan uji statistik yang sesuai dengan piranti lunak program SPSS 21. Uji hipotesis pada variabel kadar MDA akan menggunakan uji T tes tidak berpasangan bila sebaran data normal. Pada variabel skor inotropik dan vasoaktif akan menggunakan uji T test tidak berpasangan (bila sebaran data normal) atau dengan uji mann whitney(bila sebaran data tidak normal). Dan uji hipotesis untuk variabel kejadian AFPB menggunakan uji chi-squared(bila syarat x2terpenuhi) atau dengan uji fisher(bila syarat x2tidak terpenuhi).Hasil : 42 pasien yang menjalani bedah pintas arteri koroner yang memenuhi kriteria penerimaan, 40 pasien dianalisis karena 2 pasien meninggal sebelum 48 jam pertama pascabedah. Karakteristik demografi dan kadar MDA basal seimbang pada kedua kelompok. Peningkatan kadar MDA pascareperfusi lebih rendah pada pemberian allopurinol, namun secara statistik tidak berbeda bermakna (p=0,379). Nilai SIV pascabedah pada pemberian allopurinol secara statistik lebih rendah bermakna (median 6 vs 22, p=0,009). Kejadian AFPB pada kedua kelompok menunjukkan perbedaan yang tidak bermakna secara statistik (p=0,231).Simpulan : Allopurinol tidak lebih efektif daripada metilprednisolon dalam upaya mengurangi cedera reperfusi pada bedah pintas arteri koroner.

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Background: Reperfusion injury due to the release of reactive oxygen species (ROS) when using cardiopulmonary bypass (CPB) and the return of oxygen-rich blood flow to ischemic myocardium after the release of aortic clamps, can cause myocardial damage. Allopurinol as an inhibitor of xanthine oxidase, has been studied previously about its effectiveness in reducing reperfusion injury in open heart surgery which shows inconclusive results, although in some studies it has given quite good results in recovery from myocardial stunning, biomarkers of reperfusion injuries and postoperative atrial fibrilation (POAF). Methylprednisolone is also used to reduce the effects of inflammation and reperfusion injury in open heart surgery patients because of its role in indirectly inhibiting the activation of the enzyme NADPH oxidase. The aim of this study was to compare the effectiveness of oral administration of allopurinol 600 mg at night and 1 hour before surgery with 15 mg/kg intravenous methylprednisolone during anesthesia induction in reducing reperfusion injury in coronary artery bypass surgery.

Methods: A double-blind randomized clinical trial study was conducted on 42 patients undergoing coronary artery bypass surgery using CPB between October 2019 and March 2020, which was allocated to the allopurinol group or the methylprednisolone group. Examination of biomarkers of reperfusion injury is carried out by examination of a blood sample of malondialdehyde (MDA) which is performed shortly after the installation of a central venous catheter (basal) and 5 minutes after the aortic clamp are removed (post-reperfusion). MDA examination is done by the ELISA method. Assessment of vasoactive-inotropic scores (VIS) was carried out in the first 24 hours of post-surgical treatment. While the assessment of the incidence of POAF was performed during the first 48 hours after surgery. The data obtained were analyzed by the appropriate statistical tests using SPSS 21 software program. Hypothesis testing on MDA variables will use the T test unpaired if the data distribution is normal. In the VIS variables will use the T test unpaired (if the data distribution is normal) or with the Mann Whitney test (if the data distribution is not normal). And hypothesis testing for POAF variables will use the chi-square test (if the x2 requirement are met) or with the fisher test (if the x2requirements are not met).

Results:42 patients who underwent coronary artery bypass surgery who met the admission criteria, 40 patients were analyzed because 2 patients died before the first 48 hours after surgery. Demographic characteristics and basal MDA levels were balanced in both groups. The increased levels of MDA post-reperfusion were lower in allopurinol administration, but the statistics were not significantly different (p = 0.379). The postoperative VIS value in the administration of allopurinol was significantly lower than in the administration of methylprednisolone (median 6 vs 22, p = 0.009). The incidence of AFPB in the two groups showed no differences were statistically significant (p = 0.231).

Conclusion:Allopurinol is not more effective than methylprednisolone in an effort to reduce reperfusion injury in coronary artery bypass surgery. "

"Latar belakang: Program rehabilitasi jantung pada pasien pasca bedah pintas arterikoroner BPAK dapat dilaksanakan baik di rumah sakit maupun di luar rumah sakit,dimana hambatan utama pada program rehabilitasi di rumah sakit adalah jarak tempattinggal yang jauh. Mengingat kesulitan ini, untuk meningkatkan jangkauan pelayananprogram rehabilitasi jantung perlu dikembangkan ke arah program latihan mandiri dirumahdengan menggunakan pemantauan jarak jauh / telemonitor elektrokardiografi Tele-EKG .Pemantauan ini diharapkan dapat meningkatkan kepatuhan pasien terhadap programlatihan mandiri dirumah. Tujuan: Menilai efek pemantauan jarak jauh untuk meningkatkan kepatuhan pasien pascaBPAK yang menjalani program latihan mandiri. Metode: Pasien BPAK yang masuk kriteria inklusi dirandomisasi dan dibagi dua kelompok dengan dan tanpa alat pemantauan jarak jauh . Dilakukan dua kali uji latih treadmilldengan metode bruce, yaitu setelah kedua kelompok menyelesaikan program rehabilitasifase II dirumah sakit sebagai baseline, dan setelah latihan dirumah selama 12 minggupasca-intervensi sebagai evaluasi akhir program. Selanjutnya dilakukan analisis statistikantara kedua kelompok untuk melihat pengaruh pemantauan jarak jauh terhadap kepatuhanprogram latihan mandiri. Hasil penelitian: Sebanyak 44 pasien diikut sertakan pada penelitian ini. Dari hasilevaluasi, tidak didapatkan tingkat kepatuhan yang lebih baik antara kelompok intervensi n= 20 dan kontrol n = 24 95 vs 70,8 ; p = 0,054 , demikian pula peningkatan durasidan kapasitas aerobik uji latih [ 57,90 81,14 detik vs 21,67 61,22 detik; p = 0,099 , dan 0,77 1,19 METs vs 0,33 1,05 METs; p = 0,193 ]. Kesimpulan: Pasien pasca bedah pintas arteri koroner yang menjalani program latihanmandiri dengan pemantauan jarak jauh tidak mempunyai kepatuhan yang lebih baikterhadap program latihan mandiri.

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Background: Cardiac rehabilitation CR program in patient who had coronary artery bypass surgery CABG surgery could be institution based or home based, but there were many barriers for home based CR program that influence the patient's adherence to the program. As an effort to overcome the barrier of distance, confidence, and safe feeling, electrocardiography telemonitoring ECGTM could be used But there wes no data regarding the effect of the electrocardiography telemonitoring to the adherence to the home based CR program in Indonesia.

Aim: To assess the effect of electrocardiography telemonitoring to the adherence to homebased CR program for the patients who have had CABG surgery.

Methods: Patients after having CABG surgery in National Cardiovascular Center Harapan Kita Jakarta who have finished phase II CR program were recruited consecutively and were radomized to the intervention group which used ECGTM and to the control group which did not use ECGTM for 3 months home based CR program. Home based exercise was based on the result of exercise stress testing using Bruce Protocol. Adherence was defined as compliance to the minimum of 3 sessions per week for 12 weeks CR program.

Results: A total of 44 patients completed the study, The adherence to the CR program of the intervention group n 20 and control group n 24 was not different 95 vs 70,8 p 0.054 , and neither was the exercise testing duration 57.9 81.1 vs 21.7 61.2 seconds, p 0.099 , and the improvement of functional capacity 0.77 1.2 vs 0.33 1.05 METS, p 0.193.

Conclusion: The aplication of electrocardiography telemonitoring did not increase the patients adherence to home based CR program."

"Latar belakang: Berdasarkan pilot study di divisi Bedah Jantung Dewasa Rumah Sakit Pusat Jantung dan Pembuluh Darah Harapan Kita, SIRS lebih sering terjadi pada OPCAB dibandingkan dengan on-pump CABG, 67% vs 33% (30 sampel, 2017). Berangkat dari hal tersebut, peneliti melakukan uji klinis memberikan deksametason pada pasien yang menjalani operasi OPCAB. Metode: Pengumpulan sampel dilakukan secara konsekutif di divisi Bedah Jantung Dewasa Rumah Sakit Pusat Jantung dan Pembuluh Darah Harapan Kita antara Agustus 2018 - Januari 2019. Sampel yang memenuhi kriteria inklusi dan eksklusi dirandomisasi menjadi grup deksametason (n=30) dan grup plasebo (n=30). Intervensi deksametason intravena dosis 1 mg/KgBB (maksimal 100 mg) atau plasebo menggunakan normal salin (NaCl 0,9%). Analisis statistik digunakan independent t-test, Mann-Whitney test, fisher exact test dan AUC. Hasil: Insiden MACE pada grup deksametason dibandingkan grup plasebo (RR 0,385, CI 95%: 0,157-0,945, p = 0,024). Keluaran klinis lebih baik ditemukan pada grup deksametason dibandingkan grup plasebo untuk durasi ventilasi mekanik (6 (5-16) jam vs 8 (5-72) jam, p = 0,029), lama rawat ICU (17,5 (12-32) jam vs 19 (13-168) jam, p = 0,028), lama rawat rumah sakit (5 (5-8) hari vs 6,5 (5-30) hari, p = 0,04) dan VIS (0 (0-15) vs 5 (0-100), p = 0,045). Hasil penanda inflamasi, terdapat perbedaan rata-rata yang bermakna antara grup deksametason dibandingkan grup plasebo pada IL-6 (217,4 pg/mL, CI 95%: 107,9-326,8, p = 0,0001), PCT (3,41 µg/L, CI 95%: 2,1-4,71, p = 0,0001) dan CRP (52,3 mg/L, CI 95%: 28.8-75,8, p = 0,0001). Pada analisis AUC terdapat hubungan signifikan antara penanda inflamasi dengan insiden MACE pada IL-6 (AUC 0,728, CI 95%: 0,585-0,871, p = 0,005) dan PCT (AUC 0,723, CI 95%: 0,578-0,868, p = 0,007). Kesimpulan: Pemberian deksametason praoperasi OPCAB, efektif memperbaiki keluaran klinis dan mengendalikan reaksi inflamasi pascaoperasi dibandingkan plasebo.

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Background: Based on a pilot study in the Adult Heart Surgery division of Harapan Kita Heart and Vascular Center Hospital, SIRS is more common in OPCAB compared to on-pump CABG, 67% vs 33% (30 samples, 2017). Based from this result, this research conducted a clinical trial to provide dexamethasone in patients undergoing OPCAB surgery. Methods: Samples were collected consecutively in the Adult Heart Surgery division of Harapan Kita Heart and Vascular Center Hospital between August 2018 - January 2019. Samples that fulfill inclusion and exclusion criteria were randomized to dexamethasone group (n=30) and placebo group (n=30). Intervention using intravenous dexamethasone dose of 1 mg/KgBB (maximum 100 mg) or placebo using normal saline (0.9% NaCl). Statistical analysis were used independent t-test, Mann-Whitney test, fisher exact test and AUC. Results: MACE incidence in dexamethasone group compared to placebo group (RR 0.385, 95% CI: 0.157-0.945, p = 0.024). Clinical output of dexamethasone group was better than placebo group in duration of mechanical ventilation (6 (5-16) hours vs 8 (5-72 ) hours, p = 0.029), ICU length of stay (17.5 (12-32) hours vs 19 (13-168) hours, p = 0.028), hospital length of stay (5 (5-8) days vs 6.5 (5-30) days, p = 0.04) and VIS (0 (0-15) vs 5 (0-100), p = 0.045). As a result of the inflammatory markers, there was a significant average difference between dexamethasone group compared to the placebo group in IL-6 (217.4 pg/mL, 95% CI: 107.9-326.8, p = 0,0001), PCT ( 3.41 µg/L, 95% CI: 2.1-4.71, p = 0.0001) and CRP (52.3 mg/L, 95% CI: 28.8-75.8, p = 0.0001 ) In the AUC analysis there was a significant association between inflammatory markers with the incidence of MACE in IL-6 (AUC 0.728, 95% CI: 0.585-0.871, p = 0.005) and PCT (AUC 0.723, 95% CI: 0.578-0.868, p = 0.007). Conclusion: Preoperative dexamethasone OPCAB is effective to improving clinical output and controlling postoperative inflammatory reactions compared to placebo."

"Tujuan: Kegagalan dalam ekstubasi pascaoperasi pintas pembuluh darah jantung dapat mempengaruhi morbiditas dan kematian pasien. Tujuan penelitian ini adalah untuk melihat faktor risiko (intraoperasi) kegagalan ekstubasi kurang dari sama dengan 24 jam pascaoperasi pintas pembuluh darah jantung. Metode: Studi kohort retrospektif pada 315 pasien yang di operasi pintas pembuluh darah koroner jantung/ coronary artery bypass graft (CABG) yang dirawat di Ruangan Intensif Jantung RSUPN Dr. Ciptomangunkusumo dari Januari 2016 hingga Juni 2020. Pengamatan pasien selama 24 jam pascaoperasi (keluaran: ekstubasi) dengan titik potong variabel independen yaitu penggunaan mesin cardiopulmonary bypass (CPB) adalah 107 menit dan klem silang aorta adalah 84 menit. Hasil: Analisis multivariat dengan cox regresi menemukan gabungan pemakaian CPB > 107 menit dan klem silang aorta > 84 menit merupakan faktor kegagalan ekstubasi < 24 jam pascaoperasi CABG (HR 0,6; IK 95% 0,52-0,9; p-value 0,017;). Selain itu faktor preoperasi, yaitu gagal jantung NYHA III-IV (HR 0,44; IK 95% 0,23-0,85, p-value 0,015), fraksi ejeksi <40% (HR 0,58; IK 95% 0,4-0,82; p-value 0,002), pasien dengan riwayat merokok (HR 0,73; IK 95% 0,56-0,97; p-value 0,03), Gangguan fungsi ginjal (HR 0,73; ; IK 95% 0,5-0,9; p-value 0,03) merupakan faktor risiko kegagalan ekstubasi < 24 jam pascaoperasi CABG. Kesimpulan: Gabungan pemakaian mesin CPB dan klem aorta yang lama menyebabkan kegagalan ekstubasi kurang dari sama dengan 24 jam pascaoperasi CABG.

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Objective: Extubation Failure after Coronary Artery Bypass Graft (CABG) surgery can adversely affect patient morbidity and mortality. The aim this study is to see the intraoperative risk factor for extubation failure less than or equal to 24 hours postoperation CABG.

Methode: A retrospective cohort of 315 patients who underwent CABG surgery treated in the Intensive Cardiac Care RSUPN Dr. Ciptomangunkusumo within January 2016 until June 2020. Patient observation for 24 hours after CABG surgery (outcome: ekstubation), the cut of point for cardiopulmonary bypass machine (CPB) use is 107 minutes and the aortic cross clamp is 84 minutes.

Results: Multivariat analysis with cox regresion found that the use of CPB > 107 minutes and aortic cross clamp > 84 minutes is the risk factor for extubation failure less than or equal to 24 hours after CABG surgery (HR 0,6; 95% CI 0,52-0,9; p-value 0,017). In addition, preoperation risk factor, congestive heart failure NYHA III-IV (HR 0,44; 95% CI 0,23-0,85; p-value 0,015), ejection fraction < 40% (HR 0,58; 95% CI 0,4-0,82; p-value 0,002), patient with smoking history (HR 0,73; 95% CI 0,56-0,97; p-value 0,03), impaired kidney function (HR 0,73; 95% CI 0,5-0,9; p-value 0,03) is a risk factor for extubation failure less than or equal to 24 hours after CABG surgery.

Conclusion: Combination using CPB machine and aortic cross clamp for long duration causes extubation failure less than or equal to 24 hours after CABG surgery."

"Latar Belakang: Keparahan stenosis pada penyakit jantung koroner (PJK) stabil berkaitan erat dengan prognosis. Dalam memprediksi keparahan stenosis dapat digunakan beberapa faktor klinis dan ekokardiografi. Akhir-akhir ini berkembang speckle tracking echocardiography yang mampu menilai strain miokardium dan baik untuk memprediksi stenosis. Penilaian faktor-faktor klinis dan ekokardiografi strain bersama-sama diharapkan mampu memprediksi lebih baik keparahan stenosis. Tujuan: Mengetahui apakah faktor-faktor klinis (usia, jenis kelamin, diabetes, angina tipikal, riwayat infark) dan global longitudinal strain (GLS) pada ekokardiografi strain dapat memprediksi keparahan stenosis pasien PJK stabil yang dinilai dengan skor Gensini. Membuat model prediktor dari parameter yang bermakna. Metode: Studi potong lintang dilakukan di RSCM pada periode Maret-Mei 2019. Pengambilan sampel secara konsekutif pada pasien PJK stabil yang menjalani angiografi koroner. Analisis bivariat dilakukan dengan chi-square, dilanjutkan analisis multivariat dengan regresi logistik metode baickward stepwise pada variabel yang bermakna. Hasil: Terdapat 93 subjek yang masuk dalam penelitian. Pada analisis bivariat faktor-faktor prediktor yang bermakna adalah diabetes melitus (OR 2,79; IK95%:1,08-7,23), riwayat infark (OR 4,04; IK95%:1,51-10,80), angina tipikal (OR 5,01; IK95%:1,91-13,14), dan GLS ≥-18,8 (OR 30,51; IK95%:10,38-89,72). Pada analisis multivariat faktor-faktor prediktor yang bermakna adalah angina tipikal (OR 4,48; IK95%:1,39-14,47) dan GLS ≥18,8 (OR 17,30; IK95%:5,38- 55,66). Tidak dilakukan pembuatan model prediktor karena hanya 2 faktor prediktor yang bermakna. Simpulan: Angina tipikal dan GLS merupakan faktor-faktor prediktor keparahan stenosis pada pasien PJK stabil, sedangkan faktor usia, jenis kelamin, diabetes, dan riwayat infark bukan merupakan prediktor keparahan stenosis pasien PJK stabil. Model skor prediktor tidak dikembangkan karena hanya 2 faktor prediktor yang bermakna.

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Background: In patient with stable coronary artery disease (CAD), severity of stenosis is closely related to prognosis. It is known that several clinical and echocardiographic parameters can predict severity of stenosis. Recently a new method in echocardiography called speckle tracking echocardiography can be used to asses myocardial strain, which is a good predictor of stenosis severity. Assessment of clinical parameters together with strain echocardiography parameter is expected to make better prediction. Objective: To determine whether clinical factors, i.e. age, sex, diabetes, typical angina, and history of myocardial infarction, and strain echocardiography parameter, i.e. global longitudinal strain, can predict severity of coronary artery stenosis measured with Gensini score. To further develop a prediction model based on significant parameters. Methods: This is a cross-sectional study taken at Cipto Mangunkusumo Hospital during period March-May 2019. Patient with stable CAD scheduled to undergo coronary angiography is recruited consecutively. Bivariate analysis using chi- square is performed to each predictor. Significant predictors are further analysed using backward stepwise logistic regression. Results: The study group include 93 subjects. Significant predictors on bivariate analysis include diabetes melitus (OR 2.79; CI95%:1.08-7.23), history of myocardial infartion (OR 4.04; CI95%:1.51-10.80), typical angina (OR 5.01; CI95%:1.91-13.14), and GLS ≥-18.8 (OR 30.51; CI95%:10.38-89.72). Significant predictors on multivariate analysis are typical angina (OR 4.48; CI95%:1.39-14.47) and GLS ≥18.8 (OR 17.30; CI95%:5.38-55.66). Predicton model is not developed because there are only two significant predictors. Conclusions: Typical angina and GLS are predictors of stenosis severity in patient with stable CAD. Age, sex, diabetes, and history of myocardial infarction are not significant predictors. A prediction model can not developed because there are only 2 significant predictors."

"Latar belakang dan tujuan: Morbiditas dan mortalitas pascaCABG salah satunya dipengaruhi respon inflamasi oleh penggunaan mesin CPB. Di beberapa pusat, sering dilakukan pemberian kortikosteroid untuk menurunkan respon inflamasi. Terdapat berbagai uji klinis yang memberikan hasil yang masih kontroversial. Deksametason dipilih karena memiliki potensi efek glukokortikoid yang tinggi, tanpa efek mineralokortikoid, masa kerja yang panjang, relatif aman bagi pasien, serta mudah untuk didapat. Penelitian ini bertujuan untuk mengetahui apakah penggunaan deksametason lebih efektif untuk memperbaiki keluaran klinis dan mengendalikan penanda inflamasi jika dibandingkan plasebo pada pasien yang menjalani operasi CABG on pump. Metode: Randomisasi 60 sampel menjadi grup deksametason (n=30) dan grup plasebo (n=30). Variabel dengan sebaran normal dilakukan analisis statistik independent t-test, sedangkan data dengan sebaran tidak normal dilakukan analisis statistik nonparametrik yaitu Mann-Whitney test. Analisis univariat antara dua kelompok studi akan dilakukan menggunakan uji fisher exact test. Hasil: Uji statistik kejadian MACE dengan grup deksametason dibandingkan grup plasebo, didapatkan nilai RR 1,389 dengan CI 0,995-1,938 (p =0,045). Deksametason memiliki keunggulan yang dapat dilihat dari parameter durasi ventilasi mekanik (deksametason 7 (5-14) vs plasebo 10 (5-19), p <0,0001), lama rawat ICU (deksametason 16 (11-22) vs plasebo 18 (12-72), p =0,017), lama rawat rumah sakit (deksametason 5 (5-7) vs plasebo 6 (5-15), p = 0,005), penanda inflamasi IL-6 (deksametason 114 (32-310) vs plasebo 398 (72-1717), p <0,0001) dan PCT (deksametason 1,08 (0,31-3,8) vs plasebo 3,7 (1,06-11,4), p <0,0001). Simpulan: Pemberian deksametason efektif memperbaiki keluaran klinis, dan mengendalikan penanda inflamasi pascaoperasi dibandingkan plasebo.

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Background and purpose: Mortality and morbidity post CABG are affected by inflammatory response which are caused by usage of CPB machine. In some centre, corticosteroid are often used to reduce inflammatory response. There are various clinical trials that provide controversial results. Dexamethasone was chosen because it has a high potential for glucocorticoid effects, without mineralocorticoid effects, long working period, relatively safe for patients, and easy to obtain. This study aims to determine whether the use of dexamethasone is more effective in improving clinical outcomes and controlling inflammatory markers when compared to placebo in patients undergoing on pump CABG.

Methods: 60 sample are randomized into dexamethasone group (n=30) and placebo group (n=30). Variables with normal distribution were carried out independent t-test statistical analysis, whereas data with abnormal distribution were analyzed using nonparametric statistics, namely Mann-Whitney test. Univariate analysis between the two study groups will be conducted using the fisher exact test.

Result: The incidence of MACE with the dexamethasone group compared to the placebo group was obtained RR 1,389 with CI 0,995-1,938 (p =0,045). Dexamethasone has advantages that can be seen from the parameters of duration of mechanical ventilation (dexamethasone 7 (5-14) vs placebo 10 (5-19), p <0,0001). ICU stay (dexamethasone 16 (11-22) vs placebo 18 (12-72), p =0,017), hospital stay (dexamethasone 5 (5-7) vs placebo 6 (5-15), p = 0,005), IL-6 (dexamethasone 114 (32-310) vs placebo 398 (72-1717), p <0,0001) and PCT (dexamethasone 1,08 (0,31-3,8) vs placebo 3,7 (1,06-11,4), p <0,0001).

Conclusion: The administration of dexamethasone improves clinical output, and managed to controls post operative inflammatory marker more effectively compared to placebo."

"[ABSTRAKLatar belakang. Abnormalitas fungsi vena terkait inflamasi dan hipertensi vena merupakan dasar patofisiologi insufisiensi vena kronik. Pembuktian hubungan faktor inflamasi lokal pada jaringan vena dengan fungsional vena menjadi penting ketika vena yang diteliti akan menjadi konduit vena pada Bedah Pintas Arteri Koroner (BPAK) dan evaluasi patensinya berpengaruh pada mortalitas dan morbiditas pasien Penyakit Jantung Koroner (PJK).Metode. Penelitian ini merupakan studi potong lintang dari 35 sampel jaringan vena saphena magna pasien PJK yang diambil untuk konduit vena pada BPAK dan telah diperiksa IVK menggunakan Duplex Ultrasound (DUS) dengan parameter time refluks, periode bulan September sampai November 2014 di Pusat Jantung Nasional Harapan Kita. Untuk analisa hitung jumlah leukosit dilakukan pewarnaan Hematoxyllin eosin pada jaringan vena oleh ahli patologi anatomi. Analisis statistik dilakukan untuk mencari hubungan antara hitung jumlah leukosit jaringan vena dengan time refluks vena saphena magna.Hasil. Analisa statistik dengan Chi square didapatkan perbedaan bermakna peningkatan jumlah leukosit jaringan vena pada pasien insufisiensi vena kronik dibandingkan normal (52,63 % vs 18,755) dengan nilai P 0,039. Analisa lebih lanjut dengan rasio odd, dimana pasien dengan peningkatan jumlah leukosit jaringan vena memiliki 4 kali lipat kemungkinan menderita insufisiensi vena kronik (Crude OR 4,81; CI 95% 1.02 - 22.57; P value 0.046), dan setelah dianalisa menggunakan variabel perancu usia, jenis kelamin, Diabetes mellitus, Hipertensi, Perokok, Dislipidemia, adjusted OR bertambah menjadi 6 kali lipat (Adjusted OR 6,66; CI 95% 1.16 - 38.31; P value 0.033)Kesimpulan. Terdapat hubungan antara nilai inflamasi lokal dengan parameter hitung jumlah lekosit jaringan vena dengan fungsi vena pada pasien insufisiensi vena kronik dengan parameter time refluks yang diperiksa dengan DUS.

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ABSTRACTBackground: Venous function abnormality associated with inflammation and venous hypertension is the main pathophysiology of Chronic Venous Insufficiency (CVI). Proving the relationship between local inflammation factors in venous tissue and its function became an important point because the veins studied are used as a conduit for Coronary Artery Bypass Graft (CABG) procedure, and its patency evaluation will affect the mortality and morbidity rate in Coronary Artery Disease (CAD).Methods: This is a cross-sectional study, evaluating 35 Great Saphenous Veins (GSV) tissues taken as conduit for CABG procedure from CAD patients that have been previously examined using Duplex Ultrasound (DUS) for GSV reflux time from September-November 2014 at National Cardiac Centre Harapan Kita. Vein tissue samples were stained with Hematoxylin-Eosin and the vein tissue leucocyte count were evaluated by an independent anatomical pathologist. Reflux time and vein tissue leukocyte count results were then grouped into 2 categories each and analysed with chi-square test to assess the relationship between the two variablesResult: There was significant difference of elevated leukocyte count evaluated in patients with CVI according to DUS reflux time (52,63%) compared to normal ones (18.75%) (p=0.039). The risk for patients with elevated total leukocyte count to develop CVI was 4 times greater than those who have normal count (crude OR 4.81; 95% CI 1.02 to 22.57; p=0.046) and after adjusted for confounding factors, such as age, sex, and history of diabetes, hypertension, smoking, and dyslipidaemia, the risk was increased into 6 times (adjusted OR 6.66; 95% CI 1.16 to 38.31; p=0.033).Conclusion: There is significant relationship between local inflammatory factors, evaluated using total leukocyte count, with venous functions, evaluated using DUS reflux time, in CVI patients.;Background: Venous function abnormality associated with inflammation and venous hypertension is the main pathophysiology of Chronic Venous Insufficiency (CVI). Proving the relationship between local inflammation factors in venous tissue and its function became an important point because the veins studied are used as a conduit for Coronary Artery Bypass Graft (CABG) procedure, and its patency evaluation will affect the mortality and morbidity rate in Coronary Artery Disease (CAD).Methods: This is a cross-sectional study, evaluating 35 Great Saphenous Veins (GSV) tissues taken as conduit for CABG procedure from CAD patients that have been previously examined using Duplex Ultrasound (DUS) for GSV reflux time from September-November 2014 at National Cardiac Centre Harapan Kita. Vein tissue samples were stained with Hematoxylin-Eosin and the vein tissue leucocyte count were evaluated by an independent anatomical pathologist. Reflux time and vein tissue leukocyte count results were then grouped into 2 categories each and analysed with chi-square test to assess the relationship between the two variablesResult: There was significant difference of elevated leukocyte count evaluated in patients with CVI according to DUS reflux time (52,63%) compared to normal ones (18.75%) (p=0.039). The risk for patients with elevated total leukocyte count to develop CVI was 4 times greater than those who have normal count (crude OR 4.81; 95% CI 1.02 to 22.57; p=0.046) and after adjusted for confounding factors, such as age, sex, and history of diabetes, hypertension, smoking, and dyslipidaemia, the risk was increased into 6 times (adjusted OR 6.66; 95% CI 1.16 to 38.31; p=0.033).Conclusion: There is significant relationship between local inflammatory factors, evaluated using total leukocyte count, with venous functions, evaluated using DUS reflux time, in CVI patients., Background: Venous function abnormality associated with inflammation and venous hypertension is the main pathophysiology of Chronic Venous Insufficiency (CVI). Proving the relationship between local inflammation factors in venous tissue and its function became an important point because the veins studied are used as a conduit for Coronary Artery Bypass Graft (CABG) procedure, and its patency evaluation will affect the mortality and morbidity rate in Coronary Artery Disease (CAD).Methods: This is a cross-sectional study, evaluating 35 Great Saphenous Veins (GSV) tissues taken as conduit for CABG procedure from CAD patients that have been previously examined using Duplex Ultrasound (DUS) for GSV reflux time from September-November 2014 at National Cardiac Centre Harapan Kita. Vein tissue samples were stained with Hematoxylin-Eosin and the vein tissue leucocyte count were evaluated by an independent anatomical pathologist. Reflux time and vein tissue leukocyte count results were then grouped into 2 categories each and analysed with chi-square test to assess the relationship between the two variablesResult: There was significant difference of elevated leukocyte count evaluated in patients with CVI according to DUS reflux time (52,63%) compared to normal ones (18.75%) (p=0.039). The risk for patients with elevated total leukocyte count to develop CVI was 4 times greater than those who have normal count (crude OR 4.81; 95% CI 1.02 to 22.57; p=0.046) and after adjusted for confounding factors, such as age, sex, and history of diabetes, hypertension, smoking, and dyslipidaemia, the risk was increased into 6 times (adjusted OR 6.66; 95% CI 1.16 to 38.31; p=0.033).Conclusion: There is significant relationship between local inflammatory factors, evaluated using total leukocyte count, with venous functions, evaluated using DUS reflux time, in CVI patients.]"

"Latar Belakang : Morbiditas pasca operasi bedah pintas koroner BPAK masih cukuptinggi. Hal ini disebabkan karena adanya peningkatan inflamasi 48 ndash; 72 jam pasca BPAK danpeningkatan pada sistem renin angiotensin dan aldosteron RAAS. Penyekat EKA diketahuidapat menghambat RAAS dan inflamasi. Namun belum ada penelitian yang membuktikanbahwa penyekat EKA dapat menurunkan inflamasi pada pasien pasca BPAKTujuan : Mengetahui efek captopril dalam menurunkan inflamasi yang diukur menggunakanhsCRP pada pasien yang menjalani BPAK elektif.Metode : Penelitian ini merupakan studi kohort prospektif. Dilakukan di Rumah SakitJantung dan Pembuluh Darah Harapan Kita RSJPDHK pada subyek yang menjalani BPAKelektif. Durasi penelitian dilakukan pada bulan Mei hingga Oktober 2016. Subyek dibagidalam dua kelompok yaitu kelompok yang mendapatkan captorpil pasca BPAK dan tanpacaptopril. Dilakukan pemeriksaan hsCRP serial sebanyak tiga kali yaitu sebelum operasi,hari ketiga pasca operasi dan sebelum pulang rawat.Hasil Penelitian : Terdapat total 85 subyek, 49 subyek pada kelompok mendapat captoprildan 36 subyek pada kelompok tanpa captopril. Pemeriksaan hsCRP sebelum operasi dan H 3pasca BPAK menunjukkan tidak ada perbedaan pada kedua kelompok. Pemeriksaan hsCRPH 6 pasca BPAK menunjukkan hsCRP pada kelompok yang mendapatkan captopril lebihrendah 31,4 mg/L 10,5 ndash; 154 vs 46,7 mg/L 10,3 ndash; 318 dengan nilai signifikansi P=0,018.Kesimpulan : Subyek yang mendapatkan captopril mempunyai tingkat inflamasi yang lebihrendah pada H 6 pasca BPAK yang dinilai dengan hsCRP dibandingkan kelompok yangtidak mendapat captopril.

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Background Postoperative morbidity of coronary artery bypass surgery CABG is fairlyhigh. This is due to increased of inflammatory response 48 ndash 72 hour after surgery andincreased of renin angiotensin aldosteron system RAAS. ACE inhibitors are known toinhibit inflammation and RAAS. However, no study has proved that ACE inhibitors canreduce inflammation in post operative CABG.

Objective To determine the effect of captopril in reducing hsCRP post CABG surgery.

Methods This is a cohort prospective study that was conducted in Harapan Kita Hospital, on post operative elective CABG subjects on May until October 2016. Subject divided intotwo groups, the group with captopril and the other is without captopril. High sensitive CRPwas measured 3 times day 0 before surgery, day 3 post CABG, day 6 post CABG.

Results There are total 85 subjects, 49 subjects with captopril and 36 subjects withoutcaptopril. There was no difference in hsCRP results before surgery and day 3 post CABG. Inday 6 post CABG, hsCRP examination in captopril group is lower than the group withoutcaptopril 31,4 mg L 10,5 ndash 154 vs 46,7 mg L 10,3 ndash 318 with P 0,018.

Conclusion Subjects with captopril has lower hsCRP at day 6 post CABG than the subjectswithout captopril."