Disertasi

Efek Alfa-Tokoferol Parenteral dalam Mengurangi Cedera Iskemi Reperfusi Miokardium pada Operasi Definitif Tetralogi Fallot = The Effect of Parenteral Alpha-Tocopherol in Reducing Myocardial Ischemic-Reperfusion Injury in Definitive Tetralogy of Fallot Surgery.

Koreksi tetralogi Fallot (ToF) dengan penggunaan mesin pintas jantung-paru (CPB) memiliki risiko terjadinya cedera iskemia-reperfusi, terutama pada miokardium yang sianotik. Alfa-tokoferol, sebagai antioksidan kuat, diharapkan mengurangi kerusakan miokardium selama pembedahan. Kami melakukan uji klinis acak terkontrol, tersamar tunggal, dengan desain paralel di RSUPN Dr. Cipto Mangunkusumo (Mei 2022–Januari 2024). Anak usia 1 –10 tahun yang menjalani operasi koreksi ToF diacak (1:1, menggunakan perangkat lunak Randlist 1.2) untuk menerima alfa-tokoferol parenteral (4 mg/kg) atau plasebo pada saat inisiasi CPB. Alokasi disamarkan terhadap pasien, orang tua, operator bedah, dan penilai. Luaran primer adalah kadar troponin I pascaoperasi. Luaran sekunder meliputi kadar laktat, malondialdehid (MDA), skor cedera miokardium, indeks apoptosis, ekspresi glutathione peroksidase, sindrom curah jantung rendah (LCOS), lama ventilasi, lama perawatan di ICU, dan lama rawat inap. Sebanyak 58 pasien diacak (29 tiap kelompok). Troponin I lebih rendah pada kelompok alfa-tokoferol, namun tidak bermakna pada 1 jam (35,1 vs 108,8 ng/L; p = 0,919) maupun 8 jam (58,7 vs 79,5 ng/L; p = 0,417). Laktat pada 24 jam lebih rendah (0,9 vs 1,3 mmol/L; p = 0,034), dan indeks apoptosis juga lebih rendah (34 vs 55; p = 0,014). LCOS lebih jarang terjadi (3,4% vs 20,6%; p = 0,046). Tidak ditemukan perbedaan bermakna pada MDA, marker jaringan, lama ventilasi, lama ICU, maupun lama rawat inap. Tidak ada kejadian merugikan terkait intervensi. Alfa-tokoferol tidak secara nermakna menurunkan troponin I, namun menurunkan kadar laktat, indeks apoptosis, dan insidensi LCOS, sehingga menunjukkan potensi efek kardioprotektif pada operasi ToF.
Kata kunci: alfa-tokoferol, bedah jantung, ToF, troponin I


Tetralogy of Fallot (ToF) correction with cardiopulmonary bypass (CPB) poses a risk of ischemia-reperfusion injury, especially in cyanotic myocardium. Alphatocopherol, a potent antioxidant, may reduce myocardial damage during surgery. We performed a single-blind, parallel, randomized controlled trial at Cipto Mangunkusumo Hospital (May 2022–Jan 2024). Children aged 1 –10 years undergoing ToF repair were randomized (1:1, Randlist 1.2) to receive parenteral alpha-tocopherol (4 mg/kg) or placebo at CPB initiation. Allocation was blinded to patients, parents, and surgeon. The primary outcome was postoperative troponin I. Secondary outcomes were lactate, malondialdehyde (MDA), myocardial injury score, apoptosis index, glutathione peroxidase, low cardiac output syndrome (LCOS), ventilation, ICU stay, and hospital stay. Fifty-eight patients were randomized (29 per group). Troponin I was lower with alpha-tocopherol but not significant at 1 h (35.1 vs 108.8 ng/L; p = 0.919) and 8 h (58.7 vs 79.5 ng/L; p = 0.417). Lactate at 24 h was reduced (0.9 vs 1.3 mmol/L; p = 0.034), and apoptosis index was lower (34 vs 55; p = 0.014). LCOS was less frequent (3.4% vs 20.6%; p = 0.046). No significant differences were seen in MDA, tissue markers, ventilation, ICU, or hospital stay. No intervention-related adverse events occurred. Alphatocopherol did not significantly reduce troponin I but lowered lactate, apoptosis, and LCOS incidence, indicating potential cardioprotective benefit in ToF surgery.
Keyword: alpha-tocopherol, cardiac surgery, ToF, troponin I