Tesis

Pengaruh Usia Saat Operasi Lebih Dari Tiga Minggu Terhadap Kelangsungan Hidup Sepuluh Tahun Pasca Arterial Switch Operation Pada Pasien Transposition of Great Arteries Intact Ventricular Septum = The Impact of Age Beyond Three Weeks during Surgery on Ten Year Survival After Arterial Switch Operation in Transposition of Great Arteries Intact Ventricular Septum.

Latar belakang: 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 Tujuan: Mengetahui pengaruh usia saat operasi lebih dari 3 minggu terhadap kelangsungan hidup 10 tahun pasien TGA yang menjalani operasi Arterial Switch Operation Metode: Studi kohort retrospekstif 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. Pasien dengan data rekam medis yang lengkap akan dimasukkan dalam analisis. Analisis waktu terjadinya event ditentukan berdasarkan titik awal dan titik akhir penelitian. Hasil: Terdapat 139 subyek penelitian dengan median usia saat operasi adalah 39 (82553) hari. Sebanyak 39 subyek (28,1%) menjalani operasi ASO ≤ 3 minggu dan 100 pasien (71,9 %) 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). Kesimpulan: Usia saat operasi lebih dari 3 minggu tidak berpengaruh terhadap kelangsungan hidup 10 tahun pasien pasca Arterial Switch Operation
Kata Kunci: arterial switch operation, kelangsungan hidup, Transposition of great arteries intact ventricular septum.


Background : 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 less than 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 beyond three weeks on long-term survival is still controversial. Objective : To determine the effect of age at surgery and other factors on the 10-year survival of patients after Arterial Switch Operation. Methods : 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. Patients with complete medical record will be included in the analysis. Analysis of the time to evaluate the event is determined based on the starting point and end point of the study. Results : There were 139 study subjects with the median age at surgery was 39 (8-2553) hari. A total of 39 subjects (28.1 %) underwent ASO surgery ≤ 3 weeks and 100 patients (71,9%) 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). Conclusion: Age beyond three weeks during surgery did not affect the 10-year survival of patients after Arterial Switch Operation was performed.
Keyword: arterial switch operation, survival, Transposition of great arteries intact ventricular septum.