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Alfin Ridha Ramadhan
Prediktor Kesintasan Pasien Regurgitasi Aorta Berat: Tinjauan terhadap Faktor Klinis, Ekokardiografi, dan Prosedur Penggantian Katup Aorta (PKA) = Predictors of Survival in Patients with Severe Aortic Regurgitation: A Review of Clinical, Echocardiographic, and Aortic Valve Replacement (AVR) Factors
"Regurgitasi Aorta (RA) merupakan penyakit jantung katup terbanyak ketiga setelah stenosis aorta dan regurgitasi mitral dengan prevalensi sebesar 0.5% dari total populasi global. Berbagai faktor prediktor mortalitas dan kesintasan pada pasien RA telah banyak dipelajari diberbagai negara. Akan tetapi, studi yang mempelajari mengenai faktor prognostik terhadap kesintasan paska PKA pada pasien RA berat belum pernah dilakukan di Indonesia. Studi ini merupakan penelitian prognostik eksploratif dengan pendekatan kohort retroprospektif melibatkan 964 pasien dengan RA Berat yang berobat di RS Pusat Jantung Nasional Harapan Kita sejak Januari 2016 sampai Desember 2022. Dilakukan pengambilan data klinis, data ekokardiografi transtorakal, data prosedur pembedahan. Luaran primer adalah angka kesintasan dan angka mortalitas. Sebanyak total 383 pasien berhasil dilakukan analisis akhir. Sebagian besar subjek laki-laki (73,1%) dengan median usia 44 tahun (15-81). Prediktor bermakna terhadap angka kesintasan dan mortalitas pasien RA berat adalah penyakit ginjal kronis (OR 1,81, 95% CI 1,11-2,96; p<0,017), DASVKi ≥48,2 mm (OR 1,54, 95% CI 0,94-2,52;p<0,087), IMVK ≥173,5 g/m2 (OR 2,22, 95% CI 1,14-4,33;p<0,019), IVAK >34 mm/m2 (OR 2,38, 95% CI 1,18-4,79;p<0,015), Tanpa PKA (OR 4,33, 95% CI 2,68-7,00;p<0,001). Variabel Tanpa PKA merupakan prediktor angka kematian bermakna paling tinggi dengan peningkatan risiko kematian sebesar 4,33 kali (95% IK 2,688-7,00), p<0,001. Penyakit Ginjal Kronis, DASVKi ≥48,2 mm, IMVK ≥173,5 g/m2 IVAK >34 mm/m2 dan Tanpa PKA merupakan prediktor mortalitas bermakna pada pasien RA berat. Penyakit Ginjal Kronis merupakan prediktor kematian bermakna dari faktor klinis, ukuran DASVKi, IVMK, dan IVAK merupakan prediktor kematian bermakna dari faktor ekokardiografi serta Tanpa PKA merupakan prediktor kematian bermakna dari faktor prosedur bedah. Tanpa PKA merupakan prediktor angka kematian bermakna paling tinggi dengan peningkatan risiko kematian sebesar 4,33 kali.
Aortic Regurgitation (AR) is the third most common valvular heart disease after aortic stenosis and mitral regurgitation, with a prevalence of 0.5% of the global population. Various predictors of mortality and survival in AR patients have been extensively studied in different countries. However, studies focusing on prognostic factors for survival post-AVR in severe AR patients have not been conducted in Indonesia. To investigate clinical, echocardiographic, and AVR procedure predictors of survival in patients with severe AR. Methods: This is an exploratory prognostic study with a retrospective cohort approach involving 964 patients with severe Aortic Regurgitation treated at the National Heart Center Harapan Kita from January 2016 to December 2022. Data collection included clinical data, transthoracic echocardiographic data, and surgical procedure data. Primary outcomes analyzed were survival and mortality rates assessed over >1 year. A total of 383 patients were included in the final analysis. The majority of subjects were male (73.1%) with a median age of 44 years (15-81). Significant predictors of survival and mortality rates in severe RA patients are chronic kidney disease (OR 1.81, 95% CI 1.11-2.96; p < 0.017), LVESD ≥ 48.2 mm (OR 1.54, 95% CI 0.94-2.52; p < 0.087), LVMI ≥ 173.5 g/m2 (OR 2.22, 95% CI 1.14-4.33; p < 0.019), LAVI > 34 mm/m2 (OR 2.38, 95% CI 1.18-4.79; p < 0.015), and No AVR (OR 4.33, 95% CI 2.68-7.00; p < 0.001). The No AVR variable exhibits the highest significant mortality prediction with OR 4,33, 95% CI 2.688-7.00 and p < 0.001. Chronic kidney disease, LVESD ≥ 48.2 mm, LVMI ≥ 173.5 g/m2, LAVI > 34 mm/m2, and No AVR are significant mortality predictors in severe RA patients. Chronic kidney disease is a predictor of significant mortality among clinical factors, while LVEDS, LVMI, and LAVI are predictors among echocardiographic factors, and No AVR is a predictor of procedural factors. No AVR represents the highest significant mortality predictor with a 4.33-fold increased risk of death."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2024
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UI - Tugas Akhir  Universitas Indonesia Library
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Lubis, Andika Rizki
Pengaruh karakter ventrikel kiri terhadap luaran klinis jangka pendek in-hospital dan jangka menengah pasca pembedahan katup aorta pada regurgutasi aorta kronik = The effect of left ventricular character to short term in hospital and mid term clinical outcome after aortic valve replacement due to chronic aortic regurgitation
"Latar belakang: Waktu yang tepat untuk pembedahan katup aorta masihmerupakan tantangan saat ini. Pasien sering datang dengan kondisi lanjut denganperubahan geometri ventrikel kiri sebagai mekanisme kompensasi terhadappeningkatan beban tekanan dan volume berkepanjangan yang akan mempengaruhiluaran klinis pascabedah.
Tujuan: Penelitian ini bertujuan untuk mengetahuiapakah terdapat pengaruh karakter ventrikel kiri meliputi ukuran dimensi ventrikelkiri EDD, ESD, FEVKi, indeks massa ventrikel kiri LVMI terhadapmorbiditas dan mortalitas di rumah sakit pascabedah katup aorta pada pasiendengan regurgitasi aorta kronik serta luaran klinis jangka menengah.
Metode: 168 pasien dengan regurgitasi aorta kronik yang menjalani pembedahankatup aorta terseleksi sesuai kriteria inklusi dan eksklusi, pascapembedahandilakukan follow-up terhadap luaran klinis morbiditas dan mortalitas di rumahsakit, kemudian diikuti 1 tahun hingga 5 tahun setelah operasi, morbiditas danmortalitas dievaluasi,
Hasil: Tidak terdapat perbedaan bermakna pada tiap tiapparameter ventrikel kiri EDD, ESD, FEVKi, LVMI terhadap morbiditas danmortalitas saat di rumah sakit p>0,05, terdapat faktor-faktor yang mempengaruhimorbiditas intrahospital yaitu laju filtrasi ginjal p< 0,001 dan usia p=0,001 ,riwayat Penyakit Jantung Koroner PJK, riwayat PPOK dan riwayat stroke, sedangkan morbiditas jangka menengah dipengaruhi oleh kejadian aritmia pascapembedahan p=0,009, terdapat perbaikan pada NYHA functional class.Mortalitas di rumah sakit dipengaruhi oleh usia p=0,001 dan laju filtrasi ginjal p
Background: The optimal timing of aortic valve replacement is still challenging.The patients often come to hospital in end stage clinical performance withalteration in left ventricular LV geometry due to compensatory mechanism tovolume and pressure overload in long term period.
Objective: This study soughtto determine the effect of left ventricular characters diameter of the left ventricle,end diastolic diameter EDD, end systolic diameter ESD, left ventricularejection fraction LVEF, left ventricular mass index LVMI to in hospitalmorbidity and mortality following aortic valve replacement in patients withchronic aortic regurgitation and postoperative mid term outcome.
Methods: 168 patients with chronic aortic regurgitation underwent aortic valve replacementselected according to inclusion and exclusion criteria. Outcomes morbidity andmortality were observed during hospitalization and 1 year until 5 years aftersurgery. Mid term outcomes consisted of NYHA functional class, rehospitalizationand redo operation.
Results: There was no significant difference to in hospitalmorbidity and mortality for each of left ventricular characters p 0,05. Other factors which influenced in hospital morbidity were glomerularfiltration rate p"
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2017
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UI - Tugas Akhir  Universitas Indonesia Library
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Rienna Diansari
Prediktor Mortalitas In-hospital dan Kesintasan Jangka Menengah Bedah Aorta Torakalis Kompleks dibandingkan dengan Non-Kompleks = Predictors of In-Hospital Mortality and Mid-Term Survival in Patients Undergoing Complex vs Non-Complex Thoracic Aortic Surgery
"Latar Belakang: Menurut Global and Regional Burden of Aortic Dissection and Aneurysm, laju kematian akibat patologi aorta torakalis di negara berkembang lebih tinggi dibandingkan negara maju, dengan median pertambahan percepatan +0,71 per 100.000 vs +0,22 per 100.000 pada tahun 1990 dibandingkan 2010. Asia Tenggara merupakan salah satu negara dengan penambahan laju kematian tertinggi yaitu 41%. Di Indonesia, pasien datang dalam kondisi penyakit lanjut karena keterlambatan diagnosis dan manajemen dan hal ini menjadikan pasien berada pada kondisi patologi aorta yang kompleks. Kondisi patologi aorta yang kompleks tentunya membutuhkan tindakan bedah aorta yang kompleks pula. Sejauh ini belum terdapat studi yang secara khusus meneliti luaran klinis bedah aorta torakalis kompleks dibandingkan dengan non-kompleks, terutama pada populasi di negara berkembang.
Tujuan: Mengetahui hubungan kompleksitas pembedahan dengan mortalitas in-hospital dan kesintasan jangka menengah pasca bedah aorta torakalis serta faktor lain yang berhubungan.
Metode: Studi kohort retrospektif ini menggunakan data sekunder. Dilakukan pengambilan data dasar melalui rekam medis dan registri terhadap pasien pasca bedah aorta torakalis (1 Januari 2018 – 31 Desember 2021) di PJNHK. Analisa kesintasan 1 dan 3 tahun dilakukan dengan follow up melalui telepon dan pesan digital. Kemudian dilakukan analisa statistik untuk mencari hubungan antara kompleksitas pembedahan sebagai prediktor utama serta variabel lainnya dengan luaran primer (mortalitas in-hospital) dan sekunder (kesintasan jangka menengah).
Hasil: Total 208 pasien diinklusikan ke dalam analisis luaran primer; 157 (75,5%) menjalani bedah aorta torakalis kompleks dan 51 (24,5%) menjalani bedah aorta torakalis non-kompleks. Mortalitas in-hospital serupa pada kedua kelompok (23,6% vs 13,7%; p = 0,194). Pada analisa multivariat, sindrom malperfusi (OR 3,560; p = 0,002), durasi CPB > 180 menit (OR 4,331; p = 0,001), dan prioritas pembedahan (urgent OR 4,196; p = 0,003; emergency OR 10,879; p = 0,001) adalah prediktor independen mortalitas in-hospital. Follow-up kesintasan 1 dan 3 tahun pasca bedah aorta torakalis adalah 92,6% dan 80,3%, secara berurutan. Regresi Cox mengidentifikasi diabetes (HR 4,539; p = 0,025) dan status prosedur emergensi (HR 9,561; p = 0,015) sebagai prediktor independen mortalitas 1 tahun, dan diabetes (HR 3,609; p = 0,004), diseksi aorta (HR 2,795; p = 0,029) dan diameter aorta maksimum (HR 1,034; p = 0,003) sebagai prediktor independen mortalitas 3 tahun. Kompleksitas pembedahan tidak berhubungan dengan peningkatan mortalitas in-hospital maupun kesintasan jangka menengah.
Kesimpulan: Pada pasien yang menjalani tindakan bedah aorta torakalis terbuka, kompleksitas pembedahan tidak berhubungan dengan mortalitas in-hospital maupun kesintasan jangka menengah. Kesintasan jangka pendek dan menengah lebih banyak dipengaruhi faktor komorbid maupun faktor durante pembedahan
Background: According to Global and Regional Burden of Aortic Dissection and Aneurysm, a prominent increase of overall global death rate is seen on developing country compared to developed country, with relative change in median daeath rate of +0,71 per 100.000 vs +0,22 per 100.000 in 1990 vs 2010. South-east Asia is nation with highest increase of 41%. This is due to delayed in diagnosis and treatment and leads to late stage and complex aortic disease. The more complex the disease, the more complex the surgical procedure will be. Up until now, there is no data regarding the impact of surgical complexity on short and mid-term survival in patients underwent aortic surgery, especially in developing country.
Objectives: This study aimed to investigate the impact of surgical complexity on short and mid-term mortality and other influencing factors.
Methods: This retrospective cohort study used secondary data. Basic data was obtained through medical record and registry of patients underwent thoracic aortic surgery (January 1st, 2018 to December 31st, 2021) in National Cardiovascular Center Harapan Kita (NCCHK). One-year and 3-year survival analysis was obtained through phone calls and digital messages. Statistical analysis was done to investigate the impact of surgical complexity as the main predictor and other variables on primary (in-hospital mortality) and secondary (mid-term survival) outcome.
Results: A total of 208 patients were included in the analysis; 157 (75,5%) underwent complex surgery, and 51 (24,5%) underwent non-complex surgery. In-hospital mortality was similar actoss 2 groups (23,6% vs 13,7%; p = 0,1240). On multivariable analysis, malperfusion syndrome (OR 3,560; p = 0,002), CPB duration > 180 minutes (OR 4,331; p = 0,001), and surgical priority (urgent OR 4,196; p = 0,003; emergency OR 10,879; p = 0,001) were identified as independent predictor of in-hospital mortality. One and 3-year survival were 92,6% and 80,3%, respectively. Cox regression identified diabetes (HR 4,539; p = 0,025) and emergency procedure (HR 9,561; p = 0,015) as independent predictors for 1-year mortality, and diabetes (HR 3,609; p = 0,004), aortic dissection (HR 2,795; p = 0,029), and maximum aortic diameter (HR 1,034; p = 0,003) for 3-year mortality. Surgical complexity was not associated with early and mid-term mortality.
Conclusions: In patients undergoing thoracic aortic surgery, surgical complexity was not associated with early and mid-term survival. Short and mid-term survival was largely determined by patient comorbidities and intra-surgery factors."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2022
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UI - Tesis Membership  Universitas Indonesia Library
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Ismail
Luaran Penggunaan Strip Tunggal Perikardium dan Katup Mekanik dalam Penggantian Katup Aorta: Kajian terhadap Left Ventricle Reverse Remodeling, Six Minute Walking Test dan Soluble Suppression of Tumorigenicity-2 = Outcome of Single-Strip Pericardium and Mechanical Valve in Aortic Valve Replacement: Study on Left Ventricle Reverse Remodeling, Six Minute Walking Test and Soluble Suppression of Tumorigenicity-2
"Penggantian katup aorta dengan katup mekanik memerlukan biaya mahal, meningkatkan risiko endokarditis dan tromboemboli, serta memerlukan antikoagulan seumur hidup. Perikardium autolog merupakan alternatif untuk penggantian katup aorta. Tujuan penelitian ini adalah membandingkan luaran penggantian katup aorta antara katup mekanik dan perikardium autolog dengan teknik strip tunggal perikardium. Penelitian ini merupakan uji klinis terandomisasi di Pelayanan Jantung Terpadu Rumah Sakit Cipto Mangunkusumo (PJT-RSCM). Subjek dibagi ke dalam 2 kelompok berdasarkan jenis katup yang diterima, yaitu katup mekanik (kelompok mekanik) dan strip perikardium (kelompok strip). Luaran left ventricular reverse remodeling (LVRR), 6 minute walking test (6MWT), dan kadar soluble suppression of tumorigenicity-2 (sST-2) diperiksa preoperasi, 3 bulan, dan 6 bulan pascabedah. Terdapat 34 subjek yang ikut serta dari Juli 2016-Februari 2022, 17 subjek pada masing-masing kelompok. Tidak terdapat beda kejadian LVRR pada kedua kelompok, yaitu 26,7% pada kelompok mekanik dan 29,4% pada kelompok strip (p = 0,703). Pada pemeriksaan jarak 6 minute walking test (6MWT) tidak terdapat perbedaan bermakna jarak 6MWT antara kelompok strip perikardium dan kelompok mekanik pada 6 bulan pascabedah, yaitu 431,93 (SB 93,41) m vs. 404,28 (SB 79,25) m, p = 0,427 pascabedah. Kadar sST-2 kelompok mekanik 16,12 (SB 5,92) pg/mL secara bermakna lebih tinggi dibandingkan kelompok strip 11,52 (SB 6,96) pg/mL, p = 0,023) pada 6 bulan pascabedah. Disimpulkan teknik strip tunggal perikardium memiliki luaran yang sebanding dengan katup mekanik sehingga dapat digunakan sebagai alternatif penggantian katup aorta.
Aortic valve replacement with mechanical valves are quite expensive, increased the risk of adverse events such as endocarditis and thromboembolism, and requires patients to take anticoagulants for the rest of their life. Autologous pericardium is an alternative for aortic valve replacement. This study aims to compare outcomes of aortic valve replacement using mechanical valve and prosthetic valve with single-strip pericardium technique. This was a randomized clinical trial conducted at the Cipto Mangunkusumo Hospital (PJT-RSCM). Eligible subjects were randomized to either receive mechanical valve (mechanical group) or single-strip pericardium (single-strip group). Outcome assessments of left ventricular reverse remodeling (LVRR), 6 minute walking test (6MWT), and soluble suppression of tumorogenicity-2 (sST-2) were carried out at preoperation, 3 months, and 6 months postoperation. There were 34 subjects recruited from July 2016 to February 2022, 17 subjects in each groups. There was no difference in postoperative LVRR incidence between both groups, 26.7% in mechanical group vs. 29.4% in single strip group (p = 0.703). There was no significant difference of 6MWT between the mechanical and pericardial strip at six months post-operation, 404.28 (SD 79.25) m vs. 431.93 (SD 93.41) m, p = 0.427. The sST-2 level is significantly higher in mechanical group 16.12 (SD 5.92) pg/mL compared to single strip group 11.52 (SD 6.96) pg/mL, p = 0.023 at six months post-operation. We concluded that single strip pericardium technique showed comparable outcomes to mechanical valve and is considered a feasible alternative for aortic valve replacement."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2022
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UI - Disertasi Membership  Universitas Indonesia Library
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Moch Arrol Iswahyudi
Luaran 1 tahun pada pasien diseksi aorta stanford A dengan lesi hingga arkus aorta yang dilakukan pembedahan dan faktor-faktor yang berhubungan = One year outcome of post operative standford a aortic dissection with extending aortic arch lession and associated factors
"ABSTRAK
Latar belakang. Diseksi aorta Stanford A adalah penyakit dengan tingkat mortalitas yang tinggi. Penelitian ini bertujuan mencari ketahanan hidup satu tahun pasien diseksi aorta Stanford A dengan lesi hingga arkus aorta yang dibedah serta untuk mengetahui karakteristik pasien, tindakan dan faktor- faktor yang berhubungan.
Metode. Studi kohort retrospektif dengan data diambil melalui rekam medis pada pasien diseksi aorta Stanford A yang dilakukan operasi dari periode 1 Januari 2014 sampai dengan 31 Oktober 2017. Tingkat ketahanan hidup satu tahun dinilai menggunakan metode Kaplan Meier dan faktor faktor yang berhubungan dengan ketahanan hidup akan dianalisis dengan regresi Cox
ABSTRACT
Background: Stanford type A Aortic Dissection is a disease with high mortality rate. This study not only to find a one-year survival of patients with Stanford type A Aortic Dissection with lesion to the aortic arch that is dissected but also to determine patient characteristics and its related factors.
Methods: A retrospective cohort study with datas taken from medical records in Stanford type A Aortic Dissection patients who were operated from 1st January 2014 to 31st October 2017. One-year survival rate was assessed using the Kaplan-Meier method and its survival-related factors will be analyzed by Cox regression"
Depok: Fakultas Kedokteran Universitas Indonesia, 2018
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UI - Tesis Membership  Universitas Indonesia Library
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Aryo Agung Prabowo Mukti
Analisis faktor risiko kejadian kerusakan ginjal akut pascaoperasi modifikasi bentall. Perbandingan kasus diseksi aorta tipe A dan nondiseksi aorta = Risk factors analysis of Postoperative Acute Kidney Injury after Bentall modification procedure: a comparative study between type A Aortic Dissection and nondissection aortic disease
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Latar belakang: Operasi modifikasi Bentall merupakan pilihan utama terhadap tatalaksana penyakit aorta diseksi dan nondiseksi yang membutuhkan perbaikan pangkal aorta. Kerusakan ginjal akut (KGA) pascaoperasi modifikasi Bentall merupakan kejadian yang cukup sering ditemukan. Metode: Desain penelitian ini adalah kohort analitik retrospektif. Pasien dengan penyakit aorta diseksi tipe A dan nondiseksi aorta yang telah menjalani prosedur modifikasi Bentall (Januari 2015 sampai Desember 2018), dilakukan analisis faktor risiko preoperasi dan intraoperasi terhadap kejadian KGA pascaoperasi. Uji statistik dengan melakukan analisis bivariat dan multivariat. Hasil: Total subjek penelitian 82 pasien (43 pasien diseksi, dan 39 pasien nondiseksi). KGA tampak lebih besar pada kelompok diseksi (79,1% vs 39%, p = 0,001). Onset dini KGA pascaoperasi banyak ditemukan pada grup diseksi (p <0,05). Riwayat merokok (OR 4,130; p = 0,01) dan lama MHCA (OR 1,054; p = 0,001) merupakan faktor risiko yang paling memengaruhi kejadian KGA pascaoperasi tanpa membedakan stadium KGA. Simpulan: AKI pascaoperasi modifikasi Bentall ditemukan lebih banyak pada grup diseksi aorta. Riwayat merokok dan lama MHCA merupakan faktor risiko yang paling memengaruhi kejadian KGA pascaoperasi modifikasi Bentall tanpa membedakan stadium KGA. Onset kejadian KGA pascaoperasi dini didominasi oleh pasien pada grup diseksi aorta. 

Introduction: the Bentall modification procedure is considered the gold standard in treatment of patients with various aortic dissease requiring aortic root replacement. Postoperative acute kidney injury (AKI) are common among patients undergoing Bentall modification procedure. Methods: study design was retrospective cohort analytic. From January 2015 - December 2018, patients with type A aortic dissection and nondissection aortic who had undergone Bentall modification procedure was analize to find the correlation of preoperative and intraoperative risk factors with postoperative AKI. Bivariate and multivariate statistical analysis was perform. Results: 82 patients included, devided in to aortic dissection group (N = 43) and nondissection group (N = 39). Incidence of postoperative AKI found greater in aortic dissection group (79,1% vs 39%). early onset of postoperative AKI found greater in aortic dissection group (p < 0,05). History of smoking (OR 4,130; p = 0,01), and MHCA time (OR 1,054; p = 0,001) were associate with postoperative AKI. Conclusions: postoperative AKI after Bentall modification procedure found greater in aortic dissection. History of smoking and MHCA time associated with postoperative AKI after Bentall modification procedure. early onset of postoperative AKI dominated by patients in aortic dissection. 

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Jakarta: Fakultas Kedokteran Universitas Indonesia, 2019
T55581
UI - Tesis Membership  Universitas Indonesia Library
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Isman Firdaus
Efektivitas Insersi Dini Pompa Balon Intra Aorta Terhadap Mortalitas Pasien Pasca Henti Jantung Karena Sindrom Koroner Akut: Kajian terhadap Laktat, Interleukin-6, Beklin-1 dan Kaspase-3 = The Effect of Intra Aortic Balloon Pump Early Insertion on Mortality in Post Cardiac Arrest Patients with Acute Coronary Syndrome: A Study of Lactate, Interleukin-6, Beclin-1, and Caspase-3
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Kebutuhan akan dukungan sirkulasi mekaniksecara diniuntuk meningkatkan perfusi organ harus dipertimbangkandalam manajemen pasien pasca henti jantung. Pompa Balon Intra-Aorta (PBIA)merupakan alat bantu sirkulasi mekanik yang paling mudah dipakai dan tersedia di negara berkembang seperti Indonesia.Tujuan penelitian ini adalah untuk mengetahui efektivitas insersi diniPBIA terhadap mortalitas pasien pasca henti jantungkarena sindrom koroner akut (SKA).

Penelitian uji klinis yang melibatkan 60 pasieninidilakukan pada pasca henti jantung karena SKA di dilakukan RSJPDHKperiodeOktober 2017–Desember 2018K.Kriteria inklusi adalah semua pasien pasca henti jantung karena sindrom koroner akut, berusia 18–75 tahun.Kriteria eksklusi adalah terdapat riwayat strokeberdasarkan anamnesis, pupil anisokor, sudah menggunakan PBIA sebelumnya, regurgitasi aorta, sindrom brugada dan congenital long QT.Pasien dirandomisasi menjadi kelompok pelakuan dan kontrol.. Pasien dibagi menjadi dua kelompok yaitu perlakuan (n= 30) dan kontrol (n =30). Kelompok perlakuan diberikan intervensi insersi PBIA sedini mungkin dalam 3 jam pertama setelah sirkulasi spontan kembali.Pemeriksaan kadar interleukin-6, bersihan laktat efektif (BLE), beklin-1, kaspase-3, curah jantung (CJ), VTI, TAPSE, fraksi ejeksi (FE), a-vO2 diff, dan ScvO2 dilakukan di jam ke-0 dan jam ke-6 pasca kembali sirkulasi spontan.Luaran primer yang dinilai adalah mortalitas rumah sakit.,Luaransekunder yang dinilai adalahperbaikan hemodinamik, dan marka apoptosisdan kemampuanprediksi beklin-1, kaspase-3, interleukin-6 dan laktat jam ke-0 terhadap kematian. Analisisregresi cox dilakukan untuk menilai kesintasan pasien di RSdengan prinsip intention-to treat.

Sebanyak 60 pasien pasca henti jantung karena SKA, 30 di kelompok perlakuan dan 30 di kelompok kontroldiikutsertakan dalam penelitian ini.Mortalitas pada kelompok perlakuan adalah 18 (60%) pasien, sedangkan pada kelompok kontrol adalah 17 (56,67%) pasien.  ([p=0,793; hazard ratio 1,29; [IK] 95% 0,66–2,52). Tidak terdapat perbedaan kadar IL-6, BLE, beclinbeklin-1, caspasekaspase-3, curah jantung (CJ), VTI, TAPSE, fraksi ejeksi (FE), a-vO2 diff, dan ScvO2di jam ke-6 pasca SSK antara dua kelompok.Laktat, IL-6, dan kaspase-3 dapat memprediksi mortalitas pasien pasca henti jantung karena SKA, sedangkan Beklin-1 tidak dapat memprediksi kematian.

Simpulan:Pemasangan PBIA dini tidakmemperbaiki mortalitas pasien SKA pasca henti jantung. .Laktat, IL-6, dan kaspase-3 dapat memprediksi mortalitas pasien pasca henti jantung karena SKA.

The need formechanical circulatory support to improve organ perfusion may be considered inthemanagement of post cardiac arrest syndrome patients. Intra-Aortic Balloon Pump (IABP) is the most available and convenient used mechanical circulation aid especially in developing countries such as Indonesia.1This study aimed to find out whether early insertion of IABP can reduce in-hospital mortality, length of stay and death markers of cardiac arrest complicating acute myocardial infarction.

A randomized trial conducted in National Cardiovascular Center Harapan Kita (NCCHK) Hospital from October 2017–December 2018. Inclusion criteria were all post cardiac arrest due to acute coronary syndrome (ACS) patients aged 18–75 years. Exclusion criteria were history of stroke, anisocoric pupil, previous IABP use, aortic regurgitation, brugada syndrome, and congenital long QT syndrome.The intevention group was given IABP inserted as early as possible in the first 3 hours after spontaneous circulation returned.  Patients were randomized into two groups, intervention and controls. Assessment of interleukin-6, lactate clearence, beclinbeclin-1, caspasecaspase-3, cardiac output, VTI, TAPSE, ejection fraction (EF), a-vO2 Diff, and ScvO2 was done in first hour and 6 hours afterreturn of spontaneous circulation (ROSC). Primary outcome was in-hospital mortality. Secondary outcome was improved hemodynamics, apoptotic markers, and predictive ability of beclin-1, caspase-3, IL-6 and lactate in first hour after ROSC to mortality. Cox regression analysis was performed to assess in-hospital survival with the intention-to-treat principle.

A total of 60 post cardiac arrest due to ACS patients, 30 in intervention group and 30 controls included in this study. In hospital mortality of intervention group vs control was 18 (60%) vs.17 (56.67%) respectively ([p=0.793; hazard ratio 1.29; [CI] 95% 0,66–2.52). There’s no difference in IL-6, lactate clearence, beclinbeclin-1, caspasecaspase-3, cardiac output, VTI, TAPSE, ejection fraction (EF), a-vO2Diff, and ScvO2in 6 hours after ROSC between two groups. Lactate, IL-6, and caspase-3 predicts mortality of post cardiac arrest due to ACS patients while beclin-1 does not.

Conclusion:Early insertion of IABP is not improvemortality outcome of post cardiac arrest complicating acute myocardial infarctionpatients. Lactate, IL-6, and caspase-3 predicts mortality of post cardiac arrest due to ACS patients.

"
2019
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UI - Disertasi Membership  Universitas Indonesia Library
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Artati
Faktor-faktor yang berhubungan dengan readmisi pasien pasca operasi katup jantung = factors related to the readmission of patients after heart valve surgery
"Latar belakang: Penyakit katup jantung merupakan penyakit yang disebabkan ketidakmampuan katup dalam menjalankan fungsinya dengan penyebab penyakit katup jantung yang paling umum yaitu demam rematik. Walaupun telah dilakukan pembedahan, readmisi terjadi dengan angka kejadian yang terus meningkat pada pasien pasca operasi katup jantung.. Penelitian ini bertujuan mengindentifikasi faktor-faktor yang berhubungan dengan readmisi pasien pasca operasi katup jantung. Desain yang digunakan yaitu crossectional dengan pendekatan retrospektif dengan sampel sebanyak 111 responden. Uji statistik menggunakan Chi Square alternatif exact fisher dengan signifikasi (α < 0,050) menunjukan adanya hubungan yang bermakna antara tingkat pendidikan, dukungan keluarga, aktivitas fisik dan fleksibilitas, kepatuhan minum obat pengencer darah (warfarin) dengan  readmisi pasien pasca operasi katup jantung (p=0,047, p= 0,030, p= 0,030, p=0,029, p= 0,024). Direkomendasikan untuk pendidikan kesehatan pada pasien pasca operasi katup jantung dilakukan oleh perawat pendidik yang dapat memberikan edukasi kesehatan yang tepat sesuai dengan kondisi, dan mengembangkan metode untuk mencegah atau meminimalisir terjadinya readmisi, serta meningkatkan  pengetahuan dan pemahaman pasien readmisi pascaoperasi katup jantung.
Background: Heart valve disease is a disease caused by the inability of the valve to carry out its function with the most common cause of heart valve disesase, rheumatic fever. Despite surgery, readmissions occur with an increasing incidence. This study aims to identify the factors associated with patient readmissions after heart valve surgery. This research design used a cross -sectional with a retrospective approach with a sample of 111 respondents. Statictical test using Chi Square alternative exact fisher with significant ( α < 0,050) showed a significant relationship between education level, family support, physical activity and flexibility, adherence to taking blood thinners (warfarin) with patient readmission after heart valve surgery (p=0,047, p= 0,030, p= 0,030, p=0,029, p= 0,024). It is recommended that health education for post-heart valve surgery patients be carried out by educating nurses who can provide proper health education according to the conditions, and develop methods to prevent or minimize readmissions, as well as increase the knowledge and understanding of patients with postoperative heart valve readmissions."
Depok: Fakultas Ilmu Keperawatan Universitas Indonesia, 2020
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UI - Skripsi Membership  Universitas Indonesia Library
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Hervin Ramadhani
Korelasi kadar ST2 terlarut (sST2) dengan miokardial longitudinal strain speckle tracking dua dimensi untuk menilai disfungsi ventrikel kiri subklinis pada subjek stenosis aorta berat = Asscociation of the biomarkers soluble ST2 and subclinical left ventricular systolic dysfunction assessed by myocardial global longitudinal strain in patients severe aortic stenosis
"ABSTRAK
Latar belakang.
Pada pasien SA fraksi ejeksi ventrikel kiri dapat normal bahkan supra normal untuk
jangka waktu yang lama walaupun proses remodeling ventrikel kiri sudah mulai terjadi..
Ekokardiografi speckle tracking dua dimensi (EST) mempunyai kelebihan untuk
digunakan dalam menilai penurunan fungsi kontraktilitas miokard subklinis, dimana
keadaan tersebut dapat mempengaruhi prognosis pasien SA. sST2 merupakan biomarker
yang relatif baru, dapat meningkat pada regangan otot jantung (myocardial stretch),
fibrosis, inflamasi, dan injuri miokard, apakah berhubungan dengan disfungsi dini
ventrikel kiri masih belum diketahui.
Tujuan. Mengetahui korelasi sST2 terhadap nilai GLS EST pada pasien SA berat dengan
FEVK normal
Metode. Merupakan studi potong lintang. Evaluasi dilakukan pada 29 pasien stenosis
aorta berat dengan fraksi ejeksi normal yang datang ke poliklinik RS Jantung Harapan
Kita periode Februari 2015 sampai November 2015. Dilakukan pengambilan figur
ekokardiografi untuk menilai severitas SA dan untuk perhitungan nilai global longitudinal
strain speckle tracking kemudian dilakukan pengambilan sampel darah di laboratorium
RS Jantung Harapan Kita untuk menilai sST2.
Hasil Penelitian. Dua puluh sembilan subjek ikut dalam penelitian ini dengan rerata usia
adalah 59.7±12.1 tahun. Fungsi intrinsik ventrikel kiri pasien SA berat pada penelitian ini
mengalami penurunan dengan nilai rerata GLS -11±4.5%. Hasil uji korelasi menunjukan
terdapat korelasi positif dengan kekuatan korelasi sedang yang bermakna (r=0.429,
p=0.02). Analisis multivariat tetap menunjukkan adanya hubungan antara kadar sST2
dengan nilai GLS EST (r=0,282 p=0.036).
Kesimpulan. Terdapat korelasi sST2 dengan global longitudinal strain speckle tracking
pada pasien SA berat dengan fraksi ejeksi normal.ABSTRACT
Background. In severe aortic stenosis (AS), cardiac performance measured at the
ventricular chamber is typically normal or supranormal, whereas Global Longitudinal
Strain providing comprehensive information on LV myocardial contractility and is
superior in detecting subtle deteriorations. Impaired LV GLS is associated mortality risk
and reflect fibrosis. sST2 is a novel biomarker of mechanical stress, fibrosis, inflamation,
and myocardial injury. Whether sST2 is increased in relation to the subclinical LV
dysfunction assessed by GLS in AS is unknown.
Objectives. To study correlation beetwen sST2 and GLS in patients with AS severe
Methods. This is a correlation study with cross sectional design. The subject was aortic
stenosis severe patient (aortic valve area <1.0 cm2) with preserved EF (>50%) at our
outpatient clinic in Harapan Kita Hospital from February 2015 until Novenber 2015. A
comprehensive transthoracic echocardiography was performed to evaluate severity of
aortic stenosis. and echocardiographic figure recordings were stored in digital for off-line
subsequent GLS analysis. sST2 measurements were drawn after echocardiography.
Results. Twenty nine patient were enrolled in this study. The mean ages was 59.7±12.1
years. left ventricle intrinsic function in aortic stenosis patient was decreased with GLS 11±4.5%.
A
Pearson
correlate
revealed
significant
positive
correlation
between
sST2
and
GLS
(r=0.429, p=0.02). Multivariate analysis with introduced confounding factor still
showed a positive correlation between sST2 and GLS (r=0,282 p=0.036).
Conclusion. This cross sectional study demonstrated a moderate correlation between
sST2 with left ventricle global longitudinal strain speckle tracking in patients with severe
aortic stenosis with preserved EF.
;Background. In severe aortic stenosis (AS), cardiac performance measured at the
ventricular chamber is typically normal or supranormal, whereas Global Longitudinal
Strain providing comprehensive information on LV myocardial contractility and is
superior in detecting subtle deteriorations. Impaired LV GLS is associated mortality risk
and reflect fibrosis. sST2 is a novel biomarker of mechanical stress, fibrosis, inflamation,
and myocardial injury. Whether sST2 is increased in relation to the subclinical LV
dysfunction assessed by GLS in AS is unknown.
Objectives. To study correlation beetwen sST2 and GLS in patients with AS severe
Methods. This is a correlation study with cross sectional design. The subject was aortic
stenosis severe patient (aortic valve area <1.0 cm2) with preserved EF (>50%) at our
outpatient clinic in Harapan Kita Hospital from February 2015 until Novenber 2015. A
comprehensive transthoracic echocardiography was performed to evaluate severity of
aortic stenosis. and echocardiographic figure recordings were stored in digital for off-line
subsequent GLS analysis. sST2 measurements were drawn after echocardiography.
Results. Twenty nine patient were enrolled in this study. The mean ages was 59.7±12.1
years. left ventricle intrinsic function in aortic stenosis patient was decreased with GLS 11±4.5%.
A
Pearson
correlate
revealed
significant
positive
correlation
between
sST2
and
GLS
(r=0.429, p=0.02). Multivariate analysis with introduced confounding factor still
showed a positive correlation between sST2 and GLS (r=0,282 p=0.036).
Conclusion. This cross sectional study demonstrated a moderate correlation between
sST2 with left ventricle global longitudinal strain speckle tracking in patients with severe
aortic stenosis with preserved EF.
;Background. In severe aortic stenosis (AS), cardiac performance measured at the
ventricular chamber is typically normal or supranormal, whereas Global Longitudinal
Strain providing comprehensive information on LV myocardial contractility and is
superior in detecting subtle deteriorations. Impaired LV GLS is associated mortality risk
and reflect fibrosis. sST2 is a novel biomarker of mechanical stress, fibrosis, inflamation,
and myocardial injury. Whether sST2 is increased in relation to the subclinical LV
dysfunction assessed by GLS in AS is unknown.
Objectives. To study correlation beetwen sST2 and GLS in patients with AS severe
Methods. This is a correlation study with cross sectional design. The subject was aortic
stenosis severe patient (aortic valve area <1.0 cm2) with preserved EF (>50%) at our
outpatient clinic in Harapan Kita Hospital from February 2015 until Novenber 2015. A
comprehensive transthoracic echocardiography was performed to evaluate severity of
aortic stenosis. and echocardiographic figure recordings were stored in digital for off-line
subsequent GLS analysis. sST2 measurements were drawn after echocardiography.
Results. Twenty nine patient were enrolled in this study. The mean ages was 59.7±12.1
years. left ventricle intrinsic function in aortic stenosis patient was decreased with GLS 11±4.5%.
A
Pearson
correlate
revealed
significant
positive
correlation
between
sST2
and
GLS
(r=0.429, p=0.02). Multivariate analysis with introduced confounding factor still
showed a positive correlation between sST2 and GLS (r=0,282 p=0.036).
Conclusion. This cross sectional study demonstrated a moderate correlation between
sST2 with left ventricle global longitudinal strain speckle tracking in patients with severe
aortic stenosis with preserved EF.
;Background. In severe aortic stenosis (AS), cardiac performance measured at the
ventricular chamber is typically normal or supranormal, whereas Global Longitudinal
Strain providing comprehensive information on LV myocardial contractility and is
superior in detecting subtle deteriorations. Impaired LV GLS is associated mortality risk
and reflect fibrosis. sST2 is a novel biomarker of mechanical stress, fibrosis, inflamation,
and myocardial injury. Whether sST2 is increased in relation to the subclinical LV
dysfunction assessed by GLS in AS is unknown.
Objectives. To study correlation beetwen sST2 and GLS in patients with AS severe
Methods. This is a correlation study with cross sectional design. The subject was aortic
stenosis severe patient (aortic valve area <1.0 cm2) with preserved EF (>50%) at our
outpatient clinic in Harapan Kita Hospital from February 2015 until Novenber 2015. A
comprehensive transthoracic echocardiography was performed to evaluate severity of
aortic stenosis. and echocardiographic figure recordings were stored in digital for off-line
subsequent GLS analysis. sST2 measurements were drawn after echocardiography.
Results. Twenty nine patient were enrolled in this study. The mean ages was 59.7±12.1
years. left ventricle intrinsic function in aortic stenosis patient was decreased with GLS 11±4.5%.
A
Pearson
correlate
revealed
significant
positive
correlation
between
sST2
and
GLS
(r=0.429, p=0.02). Multivariate analysis with introduced confounding factor still
showed a positive correlation between sST2 and GLS (r=0,282 p=0.036).
Conclusion. This cross sectional study demonstrated a moderate correlation between
sST2 with left ventricle global longitudinal strain speckle tracking in patients with severe
aortic stenosis with preserved EF.
;Background. In severe aortic stenosis (AS), cardiac performance measured at the
ventricular chamber is typically normal or supranormal, whereas Global Longitudinal
Strain providing comprehensive information on LV myocardial contractility and is
superior in detecting subtle deteriorations. Impaired LV GLS is associated mortality risk
and reflect fibrosis. sST2 is a novel biomarker of mechanical stress, fibrosis, inflamation,
and myocardial injury. Whether sST2 is increased in relation to the subclinical LV
dysfunction assessed by GLS in AS is unknown.
Objectives. To study correlation beetwen sST2 and GLS in patients with AS severe
Methods. This is a correlation study with cross sectional design. The subject was aortic
stenosis severe patient (aortic valve area <1.0 cm2) with preserved EF (>50%) at our
outpatient clinic in Harapan Kita Hospital from February 2015 until Novenber 2015. A
comprehensive transthoracic echocardiography was performed to evaluate severity of
aortic stenosis. and echocardiographic figure recordings were stored in digital for off-line
subsequent GLS analysis. sST2 measurements were drawn after echocardiography.
Results. Twenty nine patient were enrolled in this study. The mean ages was 59.7±12.1
years. left ventricle intrinsic function in aortic stenosis patient was decreased with GLS 11±4.5%.
A
Pearson
correlate
revealed
significant
positive
correlation
between
sST2
and
GLS
(r=0.429, p=0.02). Multivariate analysis with introduced confounding factor still
showed a positive correlation between sST2 and GLS (r=0,282 p=0.036).
Conclusion. This cross sectional study demonstrated a moderate correlation between
sST2 with left ventricle global longitudinal strain speckle tracking in patients with severe
aortic stenosis with preserved EF.
"
Fakultas Kedokteran Universitas Indonesia, 2015
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I Ketut Wisudana Yuana
Hubungan Antara Severitas Anatomi Aneurisma Aorta Abdominalis Dan Kesesuaian Indications For Use Endurant Medtronic Dengan Kesuksesan Implantasi Prosedur Endovascular Aneurysma Repair Di Indonesia Tahun 2013-2019 = Relationship Between Anatomical Severity of Abdominal Aortic Aneurysm and Suitability of Indications for Use Endurant Medtronic with the Success of Implantation Endovacular Aneurysm Repair Procedures in Indonesia 2013-2019
"Latar belakang : Sejak munculnya EVAR pada 1990an, pengalaman dan teknologi mengenai stent garft semakin maju. Di RSCM pertama kali dilakukan pada tahun 2013. Menurut Ad Hoc Committee for Standarized Reporting Practices in Vascular Surgery of the Society for Vascular Surgery, keberhasilan teknis utama membutuhkan pengenalan sistem alat ini dengan baik. Sebelum melakukan tindakan EVAR, ahli bedah vaskular harus menilai severitas anatomi untuk disesuaikan dengan IFU dari Endurant Medtronics. Belum banyak penelitian yang menggambarkan hubungan antara kesesuaian teknis EVAR dengan IFU.
Metode : Penelitian ini bersifat deskriptif analitik dengan design cross-sectional pada pasien yang menjalani EVAR oleh ahli bedah vaskular di Indonesia pada tahun 2013-2019. Data ditabulasi untuk mengetahui adanya hubungan antara implantasi prosedur EVAR sesuai IFU dengan technical intraoperating complication (TIC) pada pasien AAA, dilakukan uji Chi-Square jika distribusi data normal atau Mann-Whitney test jikadistribusi data tidak normal. Pengolahan data pada penelitian ini menggunakan program SPSS 20.0 untuk membantu perhitungan statistik.
Hasil : Didapatkan 103 data aneurisma aorta abdominalis yang menjalani EVAR dari tahun 2013-2019. Terdapat 99 pasien (96.1%) pria dan 4 pasien (3.9%) wanita dan sebanyak 8 pasien (7.8%) berusia dibawah 60 tahun serta 95 pasien (92.2%) berusia diatas 60 tahun. Berdasarkan klasifikasi aortic neck severity score didapatkan 49 pasien (47.6%) memiliki klasifikasi ringan, 47 pasien (45.6%) dengan klasifikasi sedang, dan 7 pasien (6.8%) dengan klasifikasi berat. Berdasarkan klasifikasi total aortic anatomy severity score didapatkan 61 pasien (59.2%) dengan klasifikasi ringan, 42 pasien (40.8%) dengan klasifikasi sedang, dan 0 pasien (0%) dengan klasifikasi berat. Sebanyak 86 pasien (83.5%) prosedur EVAR dilakukan sesuai dengan IFU dan 17 pasien (16.5%) tidak sesuai dengan IFU. Dari data technical intraprocedure complication (TIC) didapatkan 19 pasien (18.4%) mengalami TIC dan 84 pasien (81.6%) tidak mengalami TIC. Dari penelitian ini didapatkan sebanyak 13 pasien (76.5%) yang tidak mengalami TIC dilakukan tindakan EVAR tidak sesuai IFU dan sesuai dengan IFU sebanyak 71 orang (82.6%). Sedangkan, sebanyak 4 pasien (23.5%) yang mengalami TIC dilakukan tidakan EVAR yang tidak sesuai IFU dan sebanyak 15 pasien (17,4%) yang mengalami TIC dilakukan tindakan EVAR sesuai dengan IFU. Pada data ini dihasilkan data OR (95% interval kepercayaan) sebesar 1.848 (0.385-8.864) dengan nilai p=0.556
Kesimpulan : Dari penelitian ini didapatkan hasil diameter leher proksimal, aortic neck severity score dan klasifikasi total aortic anatomyc severity secara independen memiliki hubungan yang signifikan dengan kejadian TIC pada pasien AAA di Indonesia tahun 2013-2019 dengan nilai p<0.05 dan secara umum skoring severitas anatomi memiliki pengaruh terhadap kejadian TIC setelah tindakan EVAR dan variasi anatomi menjadi pertimbangan untuk dilakukannya tindakan EVAR. Sedangkan faktor lainnya seperti panjang leher proksimal, angulasi aortic, kalsifikasi, trombus, usia, jenis kelamin, dan IFU secara independen tidak memiliki hubungan yang signifikan dengan kejadian TIC.
Background. Since EVAR in the 1990s, the experience and technology of stent-graft has advanced. At the RSCM, it was first carried out in 2013. According to the Ad Hoc Committee for Standardized Reporting Practices in Vascular Surgery of the Society for Vascular Surgery, major technical success requires a good introduction to this system of tools. Before performing an EVAR procedure, vascular surgeons must assess the severity of the anatomy to match the IFU of Endurant Medtronics. Not many studies have described the relationship between EVAR's technical suitability and IFU.
Method. This study is analytic with cross-sectional design in patients undergoing EVAR by vascular surgeons in Indonesia in 2013-2019. Data were tabulated to determine the relationship between implantation of the EVAR procedure according to IFU and technical intraoperative complication (TIC) in AAA patients, Chi-square test was performed if the data distribution was normal or the Mann -Whitney test if the data distribution was abnormal. Data processing in this study uses the SPSS 20.0 program to help statistical calculations.
Results. 103 data obtained from abdominal aortic aneurysms undergoing EVAR from 2013-2019. There were 99 patients (96.1%) male and 4 patients (3.9%) female and as many as 8 patients (7.8%) aged under 60 years and 95 patients (92.2%) aged over 60 years. Based on the classification of aortic neck severity score, 49 patients (47.6%) had a mild classification, 47 patients (45.6%) with a moderate classification, and 7 patients (6.8%) with a severe classification. Based on the total aortic anatomy severity score classification, there were 61 patients (59.2%) with mild classification, 42 patients (40.8%) with moderate classification, and 0 patients (0%) with severe classification. A total of 86 patients (83.5%) EVAR procedures were performed following IFU and 17 patients (16.5%) did not comply with IFU. From technical intraoperative complication (TIC) data, 19 patients (18.4%) experienced TIC and 84 patients (81.6%) did not experience TIC. From this study, there were 13 patients (76.5%) who did not experience TIC. EVAR measures were not performed according to IFU and according to IFU, there were 71 people (82.6%). Meanwhile, as many as 4 patients (23.5%) who experienced TIC were performed EVAR actions that were not IFU compliant and as many as 15 patients (17.4%) who experienced TIC were performed EVAR measures according to IFU. In this data generated OR data (95% confidence interval) of 1,848 (0.385-8,864) with a value of p = 0.556
Conclusion. From this study the results obtained proximal neck diameter, aortic neck severity score and total classification of aortic anatomic severity independently have a significant relationship with the incidence of TIC in AAA patients in Indonesia in 2013-2019 with a p-value <0.05 and in general the scoring of anatomical severity has an influence the occurrence of TIC after the EVAR procedure and anatomic variations are considered for the EVAR procedure. While other factors such as proximal neck length, aortic angulation, calcification, thrombus, age, sex, and IFU independently did not have a significant relationship with the incidence of TIC."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2019
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