Tesis

Perbandingan Kecepatan Pertumbuhan Arteri Pulmonal antara Pemasangan stent Alur Keluar Ventrikel Kanan dan modifiedBlalock-Thomas Taussig Shunt pada Penyakit Jantung Bawaan dengan Fisiologi Tetralogy of Fallot = Comparison of Pulmonary Artery Growth Rate between Right Ventricular Outflow Tract Stenting and modified-Blalock-Thomas Taussig Shunt in Tetralogy of Fallot Physiology.

Latar Belakang : TOF dengan kriteria risiko tinggi pembedahan membutuhkan tindakan paliatif sebelum menjalani operasi korektif yaitu TOF repair. Pemasangan stent Alur Keluar Ventrikel Kanan (Stenting AKVK) yang merupakan terapi paliatif transkateter invasif beberapa tahun terakhir muncul sebagai alternatif terhadap terapi paliatif pembedahan modified-Blalock-Thomas Taussig Shunt (mBTTS). Akan tetapi, studi mengenai pola pertumbuhan arteri pulmonal pasca stenting AKVK dan mBTTS di Indonesia belum ada. Tujuan : Membandingkan kecepatan pertumbuhan arteri pulmonal pasca stenting AKVK dan mBTTS pada Fisiologi TOF. Metode : Studi merupakan uji klinis kohort retrospektif pada pasien penyakit jantung bawaan dengan fisiologi TOF yang menjalani terapi paliatif di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita pada Desember 2019-Desember 2023. Pertumbuhan LPA dan RPA pasca terapi paliatif dinilai dengan serial ekokardiogram. Luaran primer yaitu pertumbuhan cabang arteri pulmonal harian menggunakan z-score per hari yang dianalisis dengan mixed-model. Hasil : Sebanyak total 139 pasien [pasca stenting AKVK (n=35) dan pasca mBTTS(n=104)] dengan total 492 ekokardiogram serial didapatkan median z-score RPA/hari pasca stenting AKVK (2.5 x 10-3) lebih tinggi dibandingkan mBTTS (0.9 x 10- 3) bermakna secara statistik (p < 0,001). Median z-score LPA/hari pasca stenting AKVK (1.7 x 10-3) lebih tinggi dibandingkan mBTTS (0.7 x 10-3), bermakna secara statistik (p < 0,001). Stenting AKVK memiliki rasio distribusi pertumbuhan LPA terhadap RPA secara bermakna yang lebih baik (0.93 (IQR 0.87-1.01) dibandingkan mBTTS [0.91(IQR 0.83-0.98),p < 0.01] Kesimpulan : Pertumbuhan cabang arteri pulmonal kanan dan kiri secara bermakna lebih cepat pasca stenting AKVK dibandingkan dengan mBTTS serta menghasilkan distribusi pertumbuhan cabang arteri pulmonal yang lebih simetris dibandingkan mBTTS pada pasien dengan TOF Fisiologi.
Kata kunci: mBTTS, Stenting AKVK, Tetralogy of Fallot


Background: TOF with high surgical risk criteria requires palliative therapy before undergoing corrective surgery, TOF repair. Recently, Right Ventricular Outflow Tract Stenting (RVOT stenting) has emerged as an invasive transcatheter palliative therapy alternative to modified-Blalock-Thomas Taussig Shunt (mBTTS). However, studies regarding pulmonary artery growth rate after RVOT stenting and mBTTS in Indonesia had not ever been performed. Aim: Comparing pulmonary artery growth rate after RVOT stenting and mBTTS on TOF physiology Method: The study was a clinical consecutive retrospective cohort with congenital heart disease with TOF physiology who underwent palliative therapy at the Cardiovascular Center Harapan Kita between December 2019 and December 2023. RPA and LPA growth post palliative therapy assessed by serial echocardiogram. Primary outcome was daily pulmonary artery growth represented by z-score per day and analysed using mixedmodel. Result: Total 139 patients [RVOT stenting (n=35); mBTTS (n=104) were obtained. Results of analysis of a total 492 echocardiograms, median RPA z-score/day after RVOT stenting (2.5 x 10-3) were higher significantly than mBTTS (0.9 x 10-3), p < 0.001). Median LPA z- score/day after RVOT stenting (1.7 x 10-3) were higher significantly than mBTTS (0.7 x 10-3), p < 0.001). RVOT stenting had better LPA to RPA growth distribution ratio (0.93 (IQR 0.87-1.01) than mBTTS (0.91(IQR 0.83-0.98), significantly (p < 0,01). Conclusion: RVOT stenting significantly promotes faster growth of right and left pulmonary artery branches and produces a more symmetric distribution of pulmonary artery branch growth than mBTTS in patients with TOF Physiology.
Keywords: mBTTS, RVOT stenting, Tetralogy of Fallot