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Abstrak :
Latar belakang: Arterial Switch Operation (ASO) merupakan prosedur utama pada Transposition Intact Ventricular Septum (TGA-IVS). TGA-IVS kehadiran terlambat (usia ≥30 hari) mempengaruhi kesintasan pascaprosedur ASO dan umum ditemukan di negara berkembang, termasuk Indonesia. Semakin besar usia pada populasi penyakit jantung kongenital, terutama TGA-IVS, umumnya disertai status gizi kurang. Hubungan antara status gizi terhadap kesintasan pascaprosedur ASO pada TGA-IVS kehadiran terlambat belum diketahui Metodologi: Penelitian studi potong lintang berdasarkan data sekunder dari rekam medis pada pasien TGA-IVS≥ 30 hari yang menjalani operasi ASO periode 2015-2021.Variabel utama yang dinilai adalah status gizi berdasarkan kurva status gizi WHO 2006 Variabel yang ikut dinilai antara lain usia, jenis kelamin, anomali koroner, pola anomali, jenis ASO, lama penggunaan mesin jantung paru, dan penggunaan klem silang aorta terhadap mortalitas pascaprosedur ASO. Hasil: Terdapat 89 anak dengan kehadiran terlambat; 68,53% memiliki status gizi kurang/buruk. Karakteristik pasien TGA-IVS kehadiran terlambat adalah laki-laki (67,2-67,9%), tidak memiliki anomali koroner dan memiliki pola anomali koroner normal (67,2-78,6%) dan menjalani ASO primer (67,9-68,9%). Status gizi kurang/buruk tidak memiliki hubungan terhadap risiko kemation pascaprosedur ASO (OR: 2,41, P:0,661) dibandingkan status gizi cukup. Lama mesin jantung paru merupakan prediktor mortalitas independen (p = 0,031) Kesimpulan: Status gizi rendah tidak memilki hubungan terhadap mortalitas pascaprosedur ASO pada TGA-IVS kehadiran terlambat. ......Background: Arterial Switch Operation (ASO) is the main procedure for Transposition of with Intact Ventricular Septum (TGA-IVS). Late presenter TGA-IVS (age ≥30 days) has lower postoperative ASO survival and commonly found in developing country, including Indonesia. Older age in congenital heart disease, including TGA-IVS, associated with poor nutritional status. The correlation between nutritional status and mortality post ASO in late presenter TGA-IVS remains unknown. Method: a cross sectional study based on secondary data based on medical record of late presenter TGA-IVS who undergoned ASO in 2015-202. The main measured variable is nutritional status based on WHO 2006 nutritional status curves. Other measured variables are age at intervention, gender, coronary anomaly, coronary patterns, ASO types, cardiopulmonary bypass time, aortic crosss-clamp time and hospital mortality post ASO Result: 89 children identified as late presenter TGA-IVS; 68,53% with poor nutritional status. The late presenter TGA-IVS characteristics are male (67,2-67,9%), normal coronary anatomy and pattern (67,2-78,6%), and mostly underwent primary ASO (67,9-68,9%). Poor nutritional status has no correlation (OR: 2,41, P:0,661) with mortality outcome post ASO if compared with normal nutritional status. CPB time is an independent risk factor for mortality (p = 0,031). Conclusion: No correlation between poor nutritional status with mortality outcomes post ASO procedure in late presenter TGA-IVS

Abstrak :
Transposition of Great Arteries (TGA) adalah kelainan penyakit jantung bawaan sianotik kedua yang paling sering ditemukan. Tatalaksana definitif saat ini adalah Arterial Switch Operation (ASO). Angka mortalitas pasca ASO di negara maju cukup rendah, sementara di negara berkembang sekitar 15%. Pada TGA Intact Ventricular Septum (TGA IVS), sebaiknya ASO dilakukan ≤ 3 minggu. Sedangkan, di negara berkembang, karena berbagai hal multifaktorial, ASO sering dilakukan saat usia > 3 minggu. Pengaruh usia saat operasi > 3 minggu terhadap kelangsungan hidup jangka panjang sampai saat ini masih kontroversial. Penelitian ini bertujuan untuk mengetahui pengaruh usia saat operasi > 3 minggu terhadap kelangsungan hidup 10 tahun pasien TGA yang menjalani operasi ASO. Penelitian ini merupakan studi kohort retrospekstif yang dilakukan pada pasien TGA IVS yang keluar hidup setelah operasi ASO selama periode Januari 2008-Desember 2018. Pasien kemudian dilakukan follow up untuk mengetahui kondisi hidup dan meninggal. Analisis waktu terjadinya event ditentukan berdasarkan titik awal dan titik akhir penelitian. 71,9 % pasien menjalani operasi ASO > 3 minggu. Angka kelangsungan hidup 10 tahun keseluruhan pasien pasca operasi Arterial Switch Operation sebesar 90%. Walaupun mean survival time kelompok usia operasi ≤ 3 minggu lebih panjang dibandingkan dengan kelompok usia operasi > 3 minggu (113 bulan vs 107 bulan), tetapi secara statistik tidak berbeda bermakna. Usia saat operasi > 3 minggu mempunyai risiko meningkatkan risiko kematian sebesar HR 0,49 (IK95% 0,11-2,27; p=0.86). ......Transposition of Great Arteries (TGA) is the second most common found cyanotic congenital heart disease. The current definitive management is Arterial Switch Operation (ASO). Early and long term mortality rates after ASO in developed countries are quite low, while in developing countries the number is around 15%. In TGA Intact Ventricular Septum (TGA IVS), ASO should be done in ≤ 3 weeks. However, in developing countries, due to various multifactorial causes, it is often being done at the age of > 3 weeks. The effect of age at surgery > 3 weeks on long-term survival is still controversial. This study aims to determine the effect of age at surgery and other factors on the 10-year survival of patients after ASO. A retrospective cohort study was done on TGA IVS patients that survived ASO surgery during the period of January 2008-December 2018. Patients were being followed up to find out if they are still alive. Analysis of the time to evaluate the event is determined based on the starting point and end point of the study. 71,9% patients underwent ASO surgery > 3 weeks. The overall 10-year survival rate of patients after Arterial Switch Operation is 90%. Even though the mean survival time of the operating age group ≤ 3 weeks is longer than the operation age group > 3 weeks (113 months vs 107 months), but it is not statistically significant. Age at surgery > 3 weeks had a risk of increasing the risk of death by HR 0,49 (IK95% 0,11-2,27; p=0.86).

Abstrak :
Latar belakang: Basis data bagian Bedah Jantung Anak RSPJNHK menunjukkan terdapat 133 pasien TGA IVS yang dilakukan ASO primer. Terdapat mortalitas tinggi yaitu 9% dibandingkan dengan mortalitas yang pernah dilaporkan sebelumnya yaitu 5%. Telah banyak penelitian yang memperlihatkan faktor risiko yang memengaruhi keluaran ASO primer pada TGA IVS late presenter, tetapi belum terdapat penelitian yang melaporkan keluaran prosedur tersebut di Indonesia. Jumlah kasus yang banyak di Indonesia dan tingkat mortalitas operasi yang masih tinggi menjadi alasan untuk mencari faktor risiko yang memengaruhi keluaran tersebut. Metode: Penelitian ini adalah penelitian kohort retrospektif yang melibatkan pasien TGA-IVS late presenter yang menjalani ASO primer pada tahun 2015-2022 di Rumah Sakit Pusat Jantung Nasional Harapan Kita (RSPJNHK). Variabel yang dinilai meliputi faktor praoperasi seperti usia, indeks massa ventrikel kiri, diameter dinding posterior ventrikel kiri serta faktor intraoperasi seperti lama penggunaan CPB dan klem silang aorta. Analisis bivariat dan multivariat dilakukan untuk menilai hubungan faktor risiko tersebut dengan kejadian mortalitas dini. adjusted Odds Ratio (aOR) dinilai untuk mengidentifikasi seberapa besar pengaruh faktor risiko tersebut apabila faktor lain disamakan (adjusted) Hasil: Terdapat 88 subjek yang diikutsertakan dalam penelitian ini. Median usia subjek adalah 7,2 (4-365) minggu. Kejadian morbiditas dini dialami oleh 11,7% subjek. Indeks massa ventrikel kiri merupakan faktor risiko independen yang memengaruhi keluaran mortalitas dini pasien TGA IVS late presenter yang menjalani ASO primer dengan nilai p = 0,003 serta aOR 14,02 (2,4-83,8). Lama penggunaan klem silang aorta dan mesin CPB memengaruhi keluaran mortalitas dini dengan nilai p 0,035 dan 0,011. Usia dan diameter dinding posterior ventrikel kiri tidak memengaruhi keluaran mortalitas dini pasien TGA IVS late presenter yang menjalani ASO primer. Kesimpulan: Indeks massa ventrikel kiri merupakan faktor independen yang memengaruhi mortalitas dini pada pasien TGA-IVS late presenter yang dilakukan ASO primer. Sedangkan lama penggunaan klem silang aorta dan lama penggunaan mesin CPB menjadi faktor risiko yang memengaruhi mortalitas dini untuk ASO primer pada Transposition Great Arteries–Intact Ventricular Septum late presenter. ......Background: The Pediatric Cardiac Surgery database of RSPJNHK showed that there were 133 TGA-IVS patients who underwent primary ASO. There was a high mortality rate of 9% compared to the previously reported mortality rate of 5%. There have been many studies showing risk factors affecting the outcome of primary ASO in TGA IVS late presenters, but there are no studies reporting the outcomes of the procedure in Indonesia. The large number of cases in Indonesia and the high operative mortality rate are the reasons to search for risk factors affecting the outcomes. Methods: This study was a retrospective cohort study involving the Primary Arterial Switch Operation for Late Presentation of Transposition of the Great Arteries With Intact Ventricular Septum between 2015 and 2022 at Harapan Kita National Heart Center Hospital (RSPJNHK). The variables assessed included preoperative factors such as age, left ventricular mass index, and left ventricular posterior wall diameter, and intraoperative factors like the duration of CPB use and aortic cross-clamp time. Bivariate and multivariate analyses were conducted to evaluate the association of these risk factors with the incidence of early mortality. The adjusted Odds Ratio (aOR) was calculated to determine the extent of influence these risk factors had when other variables were controlled for. Results: A total of 88 subjects were included in this study. The median age of the subjects was 7.2 (4-365) weeks. Early morbidity events were experienced by 11.7% of subjects. Left ventricular mass index was an independent risk factor affecting early mortality outcomes of late presenter TGA IVS patients undergoing primary ASO with a p value = 0.003 and aOR 14.02 (2.4-83.8). Length of use of aortic cross clamp and CPB machine influenced early mortality outcomes with p values of 0.035 and 0.011. Age and left ventricular posterior wall diameter did not affect early mortality outcomes of late presenter TGA IVS patients undergoing primary ASO. Conclusion: Left ventricular mass index, is an independent risk factor that affect early mortality of patient with TGA-IVS late presenter underwent primary ASO. While duration of aortic cross clamp use, and duration of CPB machine use are risk factors that affect early mortality of the Primary Arterial Switch Operation for Late Presentation of Transposition of the Great Arteries With Intact Ventricular Septum.