Tesis

Association between Pulmonary Vascular Resistance Index and Early Postoperative Mortality and Morbidity of Arterial Switch Operation in Transposition of Great Artery with Ventricular Septal Defect = Hubungan antara index tahanan pembuluh darah paru terhadap mortalitas dini dan morbiditas pascatindakan Arterial Switch Operation pada Transposition of Great Artery dengan Ventricular Septal Defect.

Background: Characteristics of transposition of great artery with ventricular septal defect (TGA-VSD) patients who will undergo arterial switch operation (ASO) in developing countries are mostly late-presenting cases that result in the development of pulmonary vascular obstructive disease. This study investigated whether the pulmonary vascular resistance index (PVRi) had an association and could predict early postoperative mortality and morbidity after ASO in TGA-VSD. Methods: This retrospective cohort study involved TGA-VSD patients who underwent ASO from January 2015 until December 2022 at National Cardiovascular Center Harapan Kita. Preoperative PVRi data and postoperative incidence of early mortality and morbidities such as prolonged ventilator duration, pulmonary hypertension crisis, major adverse cardiovascular event (MACE), and low cardiac output syndrome (LCOS) were collected. A bivariate analysis using independent Student's t-test was done. Diagnostic test using receiver operating characteristic (ROC) curve was also done to obtain the area under the curve (AUC) value. The best cutoff point was determined by Youden's index. Result: Forty-three subjects were involved in this study. The median age of all subjects was 9.5 (1,47 – 162) months. Subjects who experienced PH crisis (n = 10) and prolonged ventilator duration (n = 19) have significantly higher PVRi compared to subjects who did not have it (p < 0.001). There was no significant association between PVRi and early postoperative mortality, MACE, and LCOS in this population. The area under the curve of PVRi for the incidence of PH crisis and prolonged ventilator duration were 93.3% (95%CI: 85.9-100%) and 94.2% (95% CI: 87.5-100%), respectively. The best PVRi cutoff value to predict the occurrence of PH crisis was 7.15 WU.m2, with a sensitivity of 100% and specificity of 87.9%. Conclusion: The PVRi is associated with the occurrence of PH crisis and prolonged ventilator duration in patients with TGA-VSD who have undergone ASO. The PVRi could be used to predict the occurrence of these postoperative morbidities with a well-defined cut-off.
Keywords: pulmonary vascular resistance index, arterial switch operation, transposition of great arteries with ventricular septal defect, pulmonary hypertension crisis


Latar belakang Karakteristik pasien transposisi arteri besar dengan defek septum ventrikel (TGA-VSD) yang akan menjalani arterial switch operation (ASO), khususnya di negara berkembang, didominasi pasien yang terlambat untuk mendapatkan penanganan, dimana hal ini mengakibatkan timbulnya penyakit obstruktif pembuluh darah paru (PVOD). Penelitian ini untuk menilai apakah indeks resistensi pembuluh darah paru (PVRi) memiliki hubungan dan dapat memprediksi mortalitas dini dan morbiditas pascatindakan ASO pada pasien TGA-VSD. Metode: Penelitian ini merupakan studi kohort retrospektif pada pasien TGA-VSD yang menjalani ASO dari Januari 2015 hingga Desember 2022 di National Cardiovascular Center Harapan Kita. Data PVRi dan insiden kematian dini dan morbiditas pascaoperasi meliputi durasi ventilator yang memanjang, krisis hipertensi pulmonal (PH), major adverse cardiovascular event (MACE) dan low cardiac output syndrome (LCOS) diambil dari rekam medis pasien. Analisis bivariat menggunakan uji Chi-square untuk variabel nominal dan student t-test untuk variabel numerik. Uji diagnostik menggunakan kurva receiver operating characteristic (ROC) dilakukan untuk mendapatkan nilai area under the curve (AUC). Nilai cut-offterbaik ditentukan dengan menggunakan indeks Youden. Hasil: Sebanyak 43 subjek yang memenuhi kriteria dalam penelitian ini dengan nilai median usia 9,5 (1,47 – 162) bulan. Subjek yang mengalami krisis PH (n = 10) dan durasi ventilator yang memanjang (n = 19) memiliki PVRi yang lebih tinggi secara bermakna dibandingkan dengan subjek yang tidak mengalaminya (p < 0,001). Tidak ada hubungan yang bermakna antara PVRi dan kematian dini pascaoperasi, MACE, dan LCOS pada penelitian ini. AUC dari PVRi untuk kejadian krisis PH dan perpanjangan durasi ventilator adalah 93,3% (95%CI: 85,9-100%) dan 94,2% (95% CI: 87,5-100%). Nilai cutoff PVRi terbaik untuk memprediksi terjadinya krisis PH adalah 7,15 WU.m2, dengan sensitivitas 100%, spesifisitas 87,9%. Simpulan: Terdapat hubungan yang signifikan antara PVRi dan kejadian krisis PH dan perpanjangan durasi ventilator pada pasien dengan TGA-VSD yang telah menjalani ASO. Nilai cut-off PVRi dapat digunakan untuk memprediksi terjadinya morbiditas pascaoperasi.
Kata kunci: index tahanan pembuluh darah paru, arterial switch operation, transposition of great arteries dengan ventricular septal defect, krisis hipertensi pulmonal