"Pendahuluan: Bedah ganti katup jantung menggunakan cardiopulmonary bypass (CPB) berisiko menyebabkan cedera jaringan dan penurunan fungsi jantung akibat perubahan miokardium dan mekanisme iskemia/reperfusi. Penelitian ini bertujuan untuk menilai pengaruh glutamin intraoperatif terhadap fungsi ventrikel kiri dan kerusakan miokardium pascabedah ganti katup jantung.
Metode: Uji acak terkendali pada pasien dewasa yang menjalani pembedahan ganti katup jantung pada Januari-Juni 2024. Kelompok perlakuan (n=19) mendapatkan glutamin 20% intravena dosis 0,3 g/kgBB dilarutkan dalam 500 ml NaCl 0,9% dan kelompok kontrol (n=18) mendapatkan 500 mL NaCl 0,9% yang diberikan segera setelah induksi. Luaran dari penelitian adalah ejeksi fraksi (EF) dan rasio E/e’ pada 5 menit pasca off CPB dan 5 menit pasca tutup sternum, serta kadar troponin I 12 jam pasca off klem silang aorta (AoX-Clamp)
Hasil: 37 pasien diinklusikan dalam analisis. Durasi CPB lebih singkat pada kelompok perlakuan dibandingkan kontrol (39,84 ± 15,60 vs 51,33 ± 17,23 menit; p=0,030). Tidak ada perbedaan bermakna di antara kelompok perlakuan dan kontrol terhadap nilai EF pasca off CPB (56,26 ± 7,79 vs 54,33 ± 7,17 %; p=0,434), EF pasca tutup sternum (55,66 ± 7,56 vs 54,05 ± 7,27 %; p=0,515), E/e’ pasca off CPB (13,85 ± 8,83 vs 17,01 ± 10,05; p=0,315), E/e’ pasca tutup sternum (15,00 ± 8,94 vs 16,35 ± 8,80; p=0,491), dan kadar troponin I 12 jam pasca AoX-Clamp (8,29 ± 2,52 vs 8,25 ± 2,54 ng/ml; p=0,962).
Kesimpulan: Pemberian glutamin 0,3 g/kgBB intraoperatif tidak menghasilkan efek proteksi miokardium yang bermakna pada pasien pembedahan katup jantung.
Background: Heart valve replacement surgery using cardiopulmonary bypass (CPB) poses a risk of tissue injury and decreased heart function due to myocardial changes and ischemia/reperfusion mechanisms. This study aims to assess the effect of intraoperative glutamine on left ventricular function and myocardial injury following cardiac valve replacement surgery.Method: This was a randomized controlled trial in adult patients undergoing valve replacement surgery from January to June 2024. The treatment group (n=19) received 0,3 g/kg of intravenous 20% glutamine diluted in 500 mL of 0.9% NaCl, while the control group (n=18) received 500 mL of 0.9% NaCl administered immediately after induction. The study outcomes included ejection fraction (EF) and E/e’ ratio at 5 minutes post-CPB and 5 minutes post-sternum closure, as well as troponin I levels 12 hours post-aortic cross-clamp (AoX-Clamp) release.Results: 37 patients were included in the analysis. CPB duration was shorter in the treatment group compared to the control (39.84 ± 15.60 vs. 51.33 ± 17.23 minutes; p=0.030). There were no significant differences between the treatment and control groups on EF post-CPB (56.26 ± 7.79 vs. 54.33 ± 7.17%; p=0.434), EF post-sternum closure (55.66 ± 7.56 vs. 54.05 ± 7.27%; p=0.515), E/e’ post-CPB (13.85 ± 8.83 vs. 17.01 ± 10.05; p=0.315), E/e’ post-sternum closure (15.00 ± 8.94 vs. 16.35 ± 8.80; p=0.491), and troponin I levels at 12 hours post AoX-Clamp (8.29 ± 2.52 vs. 8.25 ± 2.54 ng/mL; p=0.962).Conclusion: Intraoperative administration of 0,3 g/kg glutamine did not produce significant myocardial protective effects in heart valve replacement surgery."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2024