Tesis

Prediktor Kesintasan Pasien Stenosis Aorta Berat: Tinjauan Terhadap Faktor Klinis, Ekokardiografi, dan Prosedur Penggantian Katup Aorta = Predictor of Survival in Patients with Severe Aortic Stenosis: A Review of Clinical Factors, Echocardiography, and Aortic Valve Replacement Procedures.

Latar belakang: Stenosis aorta (SA) adalah penyakit katup jantung yang umum, memiliki prevalensi sebesar 12,4% di populasi umum, dengan angka stenosis aorta berat pada pasien berusia ≥ 75 tahun mencapai 3,4%. Tingkat mortalitas dan kesintasan pasca operasi menjadi penentu luaran bagi pasien yang menjalani prosedur penggantian katup aorta. Studi khusus mengenai prediktor kesintasan pasien stenosis aorta berat belum dilakukan di Indonesia. Tujuan: Penelitian ini bertujuan untuk mengetahui faktor prediktor dari parameter klinis, ekokardiografi, hingga faktor pembedahan mempengaruhi mortalitas dan kesintasan pasien penyakit stenosis aorta berat di PJNHK. Metode: Studi kohort retrospektif melibatkan 260 pasien stenosis aorta berat bergejala dari 1 Januari 2016 hingga 1 September 2022 di PJNHK. Analisis bivariat dan multivariat dilakukan untuk mengidentifikasi prediktor kematian dan kesintasan. Kami menganalisis kesintasan dengan Kaplan-Meier. Selain itu, studi ini merancang sistem skor prediktor mortalitas awal untuk pasien stenosis aorta berat. Hasil: Pada studi ini, terdapat 260 pasien stenosis aorta berat bergejala yang didapatkan luaran klinis kejadian kematian pada studi ini 90 pasien meninggal dunia (34.6%). Variabel prognostik kejadian kematian berupa gejala gagal jantung kelas III dan IV NYHA (OR 4,70, p < 0,001), TAPSE < 17 mm (OR 3,44, p = 0,001), AVA index < 0,37 (OR 2,47, p = 0,010), E/e’ average > 15 (OR 2,18, p = 0,043), dan tidak dilakukan PKA (OR 8,25, p < 0,001). Skor prediktor mortalitas memiliki nilai diskriminasi yang baik (AUC 0,870; IK95% 0,83 – 0,92; p < 0,001; H-L 0,819). Intervensi bedah PKA merupakan prediktor kesintasan. Kesimpulan: Faktor prediktor gejala gagal jantung kelas III dan IV NYHA, TAPSE < 17 mm, AVA index < 0,37, E/e’ average > 15, dan tidak dilakukan PKA mempengaruhi kesintasan pasien stenosis aorta berat.
Kata kunci: Stenosis Aorta Berat, Kesintasan, Klinis, Ekokardiografi, Prosedur Penggantian Katup Aorta.


Background: Aortic stenosis (AS) is a common heart valve disease with a prevalence of 12.4% in the general population, and severe aortic stenosis in patients aged ≥ 75 years reaches 3.4%. Mortality rates and postoperative survival are critical outcome determinants for patients undergoing aortic valve replacement procedures. Specific studies on predictors of survival in patients with severe aortic stenosis are limited in Indonesia. Objective: This study aims to identify predictor factors, including clinical parameters, echocardiography findings, and surgical factors, influencing mortality and survival in patients with severe aortic stenosis undergoing aortic valve replacement or conservative management at the National Heart Center Harapan Kita. Methods: A retrospective cohort study involved 260 symptomatic severe aortic stenosis patients at PJNHK from January 1, 2016, to September 1, 2022. Bivariate and multivariate analyses were conducted to identify predictors of mortality and survival. Survival analysis was performed using the Kaplan-Meier method. Additionally, the study designed a scoring system as an early mortality predictor for severe aortic stenosis patients. Results: In this study, there were 260 symptomatic severe aortic stenosis patients, and the clinical outcome revealed that 90 patients passed away (34.6%). Prognostic variables for mortality included symptoms of New York Heart Association (NYHA) class III and IV heart failure (OR 4.70, p < 0.001), tricuspid annular plane systolic excursion (TAPSE) < 17 mm (OR 3.44, p = 0.001), aortic valve area (AVA) index < 0.37 (OR 2.47, p = 0.010), average E/e' > 15 (OR 2.18, p = 0.043), and absence of aortic valve replacement (AVR) surgery (OR 8.25, p < 0.001). The mortality predictor score demonstrated good discriminatory value (AUC 0.870; 95% CI 0.83 – 0.92; p < 0.001; H-L 0.819). Surgical AVR emerged as a predictor of survival. Conclusion: Predictive factors such as New York Heart Association (NYHA) class III and IV heart failure symptoms, TAPSE < 17 mm, AVA index