Tesis

Pengaruh pulmonary artery banding terhadap regurgitasi katup neoaorta pascaprosedur arterial switch operation pada transposition of the great arteries with intact ventricular septum = Effect of pulmonary artery banding on neoaortic valve regurgitation after arterial switch operation in transposition of the great arteries with intact ventricular septum.

Latar belakang : Arterial switch operation (ASO) adalah operasi pilihan untuk penanganan penyakit jantung bawaan transposition of the great arteries with intact ventricular septum (TGA IVS). Namun, terdapat komplikasi regurgitasi katup neoaorta yang memengaruhi keluaran jangka pendek dan panjang pascaprosedur ASO. Prosedur pulmonary artery (PA) banding yang merupakan bagian dari ASO dua tahap bagi pasien TGA IVS berusia di atas tiga minggu merupakan salah satu faktor risiko yang diduga memengaruhi regurgitasi katup neoaorta. Akan tetapi, belum diketahui pengaruh PA banding terhadap regurgitasi katup neoaorta pascaprosedur ASO pada pasien TGA IVS di Indonesia. Tujuan : Tujuan penelitian ini adalah mengetahui pengaruh PA banding terhadap regurgitasi katup neoaorta pascaprosedur ASO, karakteristik pasien TGA IVS, prevalensi regurgitasi katup neoaorta, dan pengaruh faktor risiko lain (rentang waktu antara PA banding dan ASO, usia, jenis kelamin, konfigurasi arteri koroner dan anatomi katup neoaorta) terhadap regurgitasi katup neoaorta pascaprosedur ASO pada TGA IVS di Rumah Sakit Pusat Jantung Nasional Harapan Kita (RSPJNHK), Indonesia. Metode : Penelitian ini adalah studi kohort retrospektif berdasarkan data sekunder dari bagian rekam medis RSPJNHK pada pasien TGA IVS yang dilakukan dan tidak dilakukan PA banding sebelum ASO pada periode 2010-2022. Variabel yang dinilai antara lain PA banding, rentang waktu antara PA banding dan ASO, usia, jenis kelamin, konfigurasi arteri koroner dan anatomi katup neoaorta. Hasil : Hasil penelitian ini terdapat 123 subjek yang terdiri dari 41 subjek kelompok PA banding dan 82 subjek kelompok tidak PA banding; median usia kelompok PA banding 14 (4–172) minggu, tidak PA banding 7 (4–364) minggu. Prevalensi regurgitasi katup neoaorta pascaprosedur ASO pada pasien TGA IVS di Indonesia adalah 37,4%; derajat regurgitasi ringan mendominasi pada kelompok PA banding tidak PA banding sebelum ASO dengan persentase 74,0% dan 60,9%. Pulmonary artery banding memiliki hubungan bermakna secara statistik (p = 0,010) dengan regurgitasi katup neoaorta dalam analisis multivariat dan meningkatkan regurgitasi katup neoaorta 3,01 (IK 95% 1,30 – 6,95) kali dibandingkan tanpa PA banding. Rentang waktu lambat antara PA banding dan ASO memiliki hubung an bermakna secara statistik (p = 0,010) dengan regurgitasi katup neoaorta dalam analisis bivariat subgrup dan meningkatkan regurgitasi katup neoaorta 2,46 (IK 95% 1,21 – 5,00) kali dibandingkan dengan rentang waktu cepat. Simpulan : Berdasarkan penelitian ini, PA banding dan rentang waktu lambat antara PA banding dan ASO memiliki hubungan bermakna secara statistik dengan regurgitasi katup neoaorta dan meningkatkan risiko regurgitasi katup neoaorta pada pasien TGA IVS yang menjalani ASO.
Kata kunci : pulmonary artery banding, regurgitasi, katup neoaorta, arterial switch operation


Background : Arterial switch operation (ASO) is the treatment of choice for transposition of the great arteries with intact ventricular septum (TGA IVS). However, regurgitation of neoaortic valve was one complication that affect the short-term and longterm outcome after ASO. Pulmonary artery (PA) banding procedure, the first of two step in two-stage ASO done particularly for patient older than three weeks old, was thought to be the risk factor for developing neoaortic valve regurgitation. However, there was no data supporting this statement in Indonesia. Aim : The aim of this study is to understand the effect of PA banding on neoaortic valve regurgitation after ASO in TGA IVS, patient’s characteristics, prevalence of neoaortic valve regurgitation and effect of other risk factors (age, gender, time interval between PA banding and ASO, coronary artery configuration and neoaortic valve anatomy) on neoaortic valve regurgitation after ASO in TGA IVS in National Cardiovascular Center Harapan Kita (NCCHK), Indonesia. Method : This study was a retrospective cohort based on secondary data from medical record of NCCHK on patient with TGA IVS who underwent and not underwent PA banding prior to ASO in 2010 to 2022 time period. The variables assessed including PA banding, time interval between PA banding and ASO, age, gender, coronary artery configuration and neoaortic valve anatomy. Result : There were 123 subjects in this study, consisted of 41 subjects in PA banding group and 82 subjects in non PA banding group; median age in PA banding group was 14 (4–172) weeks, non PA banding group 7 (4–364) weeks. Prevalence of neoaortic valve regurgitation post ASO in TGA IVS in Indonesia was 37.4%; with mild regurgitation dominated in PA banding and non PA banding prior to ASO group with percentage of 74.0% and 60.9%, respectively. Pulmonary artery banding had statistically significant correlation (p = 0,010) with neoaortic valve regurgitation in multivariate analysis and increasing risk of developing regurgitation by 3,01 (CI 95% 1,30 – 6,95) compared with non PA banding. Late time interval between PA banding and ASO had statistically significant correlation (p = 0.010) with neoaortic valve regurgitation in subgroup bivariate analysis and increasing risk of developing regurgitation by 2.46 (CI 95% 1.21 – 5.00) compared with rapid time interval between PA banding and ASO. Conclusion : Based on this study, PA banding dan late time interval between PA banding and ASO had statistically significant correlation with neoaortic valve regurgitation and increasing risk of developing neoaortic valve regurgitation in TGA IVS patient underwent ASO.
Keywords : pulmonary artery banding, regurgitation, neoaortic valve, arterial switch operation