Tesis

Durasi Mesin Pintas Jantung-Paru dan Durasi Klem Silang Aorta Sebagai Prediktor Fibrilasi Atrium Pascabedah Pintas Arteri Koroner dengan Mesin Pintas Jantung-Paru = Duration of Cardiopulmonary Bypass and Aortic Cross Clamp as Predictors of Postoperative Atrial Fibrillation After OnPump Coronary Artery Bypass Graft.

Latar Belakang: Durasi mesin pintas jantung-paru (PJP) dan durasi klem silang aorta (KSA) memengaruhi kejadian fibrilasi atrium pascabedah pintas arteri koroner dengan mesin pintas-jantung paru. Peningkatan durasi meningkatkan cedera iskemik-reperfusi miokardium, inflamasi sistemik, stres oksidatif, remodelling atrium, perubahan struktural, ketidakseimbangan elektrolit dan aktivasi simpatis. Metode: Penelitian ini merupakan kohort retrospektif dari pasien penyakit jantung koroner (PJK) yang menjalani bedah pintas arteri koroner dengan mesin pintas jantungparu. Variabel independen adalah durasi PJP dan durasi KSA. Variabel dependen kejadian fibrilasi atrium pascaoperasi (POAF). Analisis bivariat, multivariat, dan kurva ROC dilakukan pada variabel lain, perancu, independen terhadap variabel dependen. Hasil: Sebanyak 901 subjek masuk dalam penelitian. Terdapat perbedaan yang signifikan pada durasi PJP dan durasi KSA terhadap kejadian POAF. Kurva ROC durasi PJP dengan nilai AUC 0,740 (95% IK 0,705 – 0,775) dan nilai cut-off 99,5 menit dengan nilai sensitivitas 55,8% dan spesifisitas 81,5%, kurva ROC durasi KSA dengan nilai AUC 0,729 (95% IK 0,694 – 0,763) dan nilai cut-off53,5 menit dengan nilai sensitivitas 50,6% dan spesifisitas 80,2%. Tidak didapatkan perbedaan signifikan antara jenis kelamin, perokok, riwayat keluarga PJK, hipertensi, dislipidemia, diabetes melitus, strok, PPOK fraksi ejeksi, TAPSE, dan diameter atrium kiri terhadap kejadian POAF. Terdapat perbedaan signifikan antara usia, CRP, dan jumlah anastomosis terhadap kejadian POAF. Kesimpulan: Durasi mesin pintas jantung-paru dan durasi klem silang aorta merupakan prediktor independen terhadap kejadian fibrilasi atrium pascabedah pintas arteri koroner dengan mesin pintas jantung-paru.
Kata kunci: bedah pintas arteri koroner, durasi mesin pintas jantung-paru; PJP; durasi klem silang aorta; KSA; fibrilasi atrium pascaoperasi; POAF; cut-off


Background: Durations of Cardiopulmonary bypass (CPB) and aortic cross-clamp (AOX) time increase the likelihood of postoperative atrial fibrillation (POAF) after onpump coronary artery bypass graft (CABG). Increasing duration increases myocardial ischemia-reperfusion injury, systemic inflammation, oxidative stress, atrial remodeling, structural changes, electrolyte imbalance and sympathetic activation. Methods: This retrospective cohort study was conducted in CAD patients underwent onpump CABG. CPB and AOX durations were the independent variables and POAF was the dependent variable. Bivariate, multivariate, and ROC analyses were performed. Results: There were 901 subjects included for the analysis. CPB duration and AOX duration were significantly associated with POAF. ROC analysis for CPB duration showed an AUC of 0,740 (95% CI 0,705 - 0,775) with a cut-off of 99,5 minutes (sensitivity 55,8%, specificity 81 ,5%). AOX duration had an AUC of 0,729 (95% CI 0,694 - 0,763) with a cut-off of 53,5 minutes (sensitivity 50,6%, specificity 80,2%). No significant associations were found for sex, smoking status, family history of coronary disease, hypertension, dyslipidemia, diabetes mellitus, stroke, COPD, ejection fraction, TAPSE, and left atrial diameter. Age, CRP, and number of anastomoses were significantly associated with POAF. Conclusion: CPB and AOX durations are independent predictors of postoperative atrial fibrillation after on-pump CABG.
Keywords: Coronary artery bypass graft; cardiopulmonary bypass duration; CPB; aortic cross-clamp duration; AOX; postoperative atrial fibrillation; POAF; cut-off