Tesis

Faktor Risiko yang Memengaruhi Keluaran Jangka Pendek Operasi Fontan pada Anak Usia diatas Enam Tahun = Risk factors affecting short-term post operative outcome of Fontan surgery in children over six years old.

Latar belakang: Prosedur Fontan merupakan prosedur paliatif pada penyakit jantung bawaan univentrikel atau pada penyakit jantung bawaan dengan struktur intra kardiak yang kompleks yang tidak dapat reparasi secara biventrikel. Usia tua saat dilakukan prosedur Fontan memengaruhi kesintasan pascaoperasi. Berdasarkan basis data bedah jantung pediatrik Rumah sakit pusat jantung nasional harapan kita (RSPJNHK) di Indonesia, sebagian besar pasien yang manjalani prosedur Fontan berada pada usia tua. Dengan mengetahui faktor risiko yang memengaruhi keluaran pascaoperasi jangka pendek pada pasien usia tua diharapkan dapat menurunkan lama rawat, komplikasi, dan kematian dini, serta meningkatkan kesintasan pascaoperasi Fontan. Metode: Penelitian ini adalah studi kohort retrospektif berdasarkan data sekunder dari bagian rekam medis RSPJNHK Indonesia pada pasien usia tua yang telah menjalani operasi Fontan pada periode 2017-2021. Variabel yang dinilai antara lain fungsi ventrikel, rasio McGoon, indeks resistensi arteri pulmonalis, gradient transpulmonalis, lama penggunaan mesin jantung paru, penggunaan klem silang aorta, dan tekanan sirkulasi Fontan terhadap lama rawat, komplikasi pasca operasi, dan kematian dini. Hasil: Hasil penelitian terdapat total 93 anak diatas enam tahun yang menjalani operasi Fontan; usia 10,2 ± 4,6, laki-laki 43(46,2%) dan perempuan 50(53,8%), tidak didapatkan hubungan antara variabel penelitian terhadap lama rawat. Terdapat hubungan antara rasio McGoon (p = 0,011 ) terhadap kejadian kematian dini. Komplikasi pasca operasi lebih tinggi pada kelompok dengan indeks resistensi arteri pulmonalis > 2 WU(70,6%) dibanding < 2 WU( 40,7%) (p = 0,008) OR 0,22(0,73-0,68), dan pada kelompok dengan rasio McGoon < 1,8(78,8%) dibanding > 1,8(78,8%) ( p = 0,002) OR 0,15(0,05-0,48) dan juga didapatkan hubungan lama penggunaan mesin jantung paru (p = 0,003) OR 1,03(1- 1,05) terhadap komplikasi secara keseluruhan. Simpulan: Berdasarkan penelitian beberapa variabel memilki hubungan yang bermakna secara statistik terhadap keluaran pascaoperasi Fontan pada anak usia diatas 6 tahun. Rasio McGoon 2 WU, rasio McGoon < 1,8, dan lama penggunaan CPB memiliki hubungan yang bermakna terhadap komplikasi pascaoperasi. Tidak terdapat hubungan yang bermakna antara variabel penelitian dengan lama rawat pascaoperasi
Kata Kunci: Fontan, rasio McGoon, indeks resistensi arteri pulmonalis.


Background: The Fontan procedure is a palliative procedure in univentricular congenital heart disease or in congenital heart disease with complex intracardiac structures that cannot be repaired biventricularly. Older age at the time of the Fontan procedure affects postoperative survival. Based on the pediatric cardiac surgery database at the Harapan Kita National Cardiovascular Center Hospital in Indonesia, most of the patients undergoing the Fontan procedure are of old age. Knowing the risk factors that affect shortterm postoperative outcomes in older patients is expected to reduce length of stay, complications, and mortality, and increase Fontan's postoperative survival. Method: This study is a retrospective cohort study based on secondary data from the medical record section of the Harapan Kita National Cardiovascular Center Hospital in patients who had undergone Fontan surgery in older age in the 2017-2021 period. The variable assessed included ventricular function, McGoon ratio, pulmonary artery resistance index, transpulmonary gradient, duration of cardiopulmonary bypass, use of aortic cross clamp, fenestration, postoperative saturation, and Fontan circulation pressure on length of stay, postoperative complications, and mortality. Result: The results of the study were a total of 93 children over six years who underwent Fontan surgery; age 10,2 ± 4,6, male 43 (46,2%) and female 50 (53,8%), there was no relationship between study variables and length of stay. There is a relationship between McGoon's ratio (p = 0,011) to the incidence of early mortality. Postoperative complications were higher in the group with pulmonary artery resistance index > 2 WU (70,6%) than < 2 WU(40,7%) (p = 0,008) OR 0,22(0,73-0,68), and in the group with McGoon ratio < 1,8(78,8%) compared to > 1,8(78,8%) (p = 0,002) OR 0,15(0,05-0,48) and duration of cardiopulmonary bypass (p = 0.003) OR 1.03(1 -1.05) on composite complications. Conclusion: Based on the research, several variables had a statistically significant relationship with the short-term postoperative outcome of Fontan in children aged over six years. McGoon's ratio 2 WU, McGoon ratio < 1.8, and duration of cardiopulmonary bypass had a significant relationship to postoperative complications. There was no significant relationship between the study variables and postoperative length of stay.
Key Words: Fontan, McGoon ratio, pulmonary artery resistance index