Tesis

Early post-operative mortality between surgical repair with and without coronary artery bypass grafting in post-infarction ventricular septal rupture = Hubungan Antara Tindakan Konkomitan Bedah Pintas Arteri Koroner dan Operasi Perbaikan Ruptur Septum Ventrikel pada Kasus Rupture Septum Ventrikel Pasca Infark Miokard Acute.

Background Post-infarction ventricular septal rupture (VSR) is a rare life-threatening complication of acute myocardial infarction (AMI). Untreated VSR has a poor and fatal outcome. Surgical repair of VSR remains the treatment of choice. Concomitant CABG is recommended as an additional procedure as a way of revascularization. A study regarding the operative outcomes of VSR surgical repair along with concomitant CABG has not been conducted in Indonesia. Hence, this study aims to investigate the association between concomitant CABG and early post-operative mortality in post-infarction VSR undergoing surgical repair. Methods: This is a retrospective cohort study which includes a CAD patient with post-infarction VSR who underwent surgical repair with and without concomitant CABG at the Adult Cardiac Surgery Unit, National Cardiovascular Center Harapan Kita from January 2018 -to December 2023. Patients’ characteristics include age, gender, comorbidities, preoperative left ventricular ejection fraction, preoperative cardiogenic shock, location of rupture and concomitant CABG surgery. Post operative outcomes recorded were early mortality which includes in-hospital and thirty-day mortality. Result A total of thirty-four subjects were included in this study with 22 patients (64.7%) undergoing concomitant CABG. The incidence of mortality in those undergoing VSR surgical repair is 38.2%. Incidence of mortality in patients undergoing concomitant CABG is lower than patients without CABG, however it is not statistically significant. Adjusted OR showed a slight protective effect of CABG towards post-operative mortality (Adjusted OR 0.3, p = 0.167). Although it is not statistically significant, preoperative left ventricular ejection fraction, preoperative cardiogenic shock, and location of rupture are also associated with post-operative mortality. Conclusion VSR surgical repair in concomitant with CABG showed lower post-operative mortality and protective effect while preoperative left ventricular ejection fraction, preoperative cardiogenic shock, location of rupture are associated with post-operative mortality in patients undergoing VSR surgical repair.
Keywords: myocardial infarction, ventricular septal rupture, surgical repair, coronary artery bypass grafting, early mortality


Latar belakang Ruptur septum ventrikel merupakan komplikasi mekanik yang jarang namun mengancam nyawa infark miokard akut. Apabila tidak tertangani, kasus ini mempunya prognosis yang buruk dan fatal. Operasi perbaikan ruptur merupakan tatalaksana utama. Bedah Pintas Arteri Koroner (BPAK) direkomendasikan untuk dlakukan secara konkomitan untuk revaskularisasi jantung. Studi mengenai luaran pasca operasi perbaikan rupture septum ventrikel belum pernah dilakukan di Indonesia. Penelitian ini bertujuan mengetahui hubungan antara tindakan konkomitan BPAK terhadap mortalitas pasca operasi perbaikan rupture septum ventrikel. Metode: Penelitian ini menggunakan metode studi kohort retrospektif pada pasien terdiagnosis ruptur septum ventrikel pasca infark miokard yang menjalan operasi perbaikan rupture dengan atau tanpa tindakan konkomitan BPAK di Unit Bedah Jantung Dewasa Pusat JAntung Nasional Harapan Kita sejak Januari 2018 hingga Desember 2023. Data yang diambil meliputi karakteristik pasien seperti umur, jenis kelamin, komorbiditas, fraksi ejeksi jantung kiri, status syok kardiogenik, dan lokasi ruptur septum ventrikel. Hasil Sebanyak tiga puluh empat pasien termasuk dalam kriteria penelitian. Tindakan konkomitan BPAK dilakukan pada 22 pasien (64,7%). Insiden kematian pasca operasi perbaikan ruptu septum sebanyak 38,2%. Insidens kematian pasca operasi konkomitan BPAK lebih rendah dibandingkan kelompok pasien yang menjalani operasi perbaikan rupture septum saja walaupun hasil ini tidak bermakna secara statistic. Perhitungan multivariat menunjukkan bahwa operasi konkomitan BPAK memberikan efek protektif terhadap pasien pasca operasi (Adjusted OR 0,3, p = 0,167). Walaupun secara statistik tidak bermakna, fraksi ejeksi jantung kiri, status syok kardiogenik, dan lokasi ruptur septum ventrikel diasosiasikan dengan peningkatan mortalitas pasca operasi. Simpulan Tindakan konkomitan BPAK diasosiasikan dengan mortalitas pasca operasi yang lebih rendah and memberikan efek protektif. Faktor preoperatif seperti fraksi ejeksi jantung kiri, status syok kardiogenik, dan lokasi rupture septum ventrikel memengaruhi mortalitas pasca operasi perbaikan septum ventrikel.
Kata kunci: infark miokard, ruptur septum ventrikel, operasi perbaikan ruptur septum ventrikel, bedah pintas arteri koroner, mortalitas pasca operasi.