Skripsi

Midterm Major Cardiovascular Event And Rehospitalization In Borderline And Low Pulmonary Vascular Resistance Index Patients Following Asd Ph Surgical Repair.

Introduction As Pulmonary Vascular Resistance Index (PVRi) levels remain a large deciding vote for patient ASD-associated PH operability, this study looks to compare the midterm postoperative outcome of ASD-PH patients with Low and Borderline PVRi (< 4 WU ·m2, and 4-8 WU ·m2, respectively) in a unique patient demographic found in Indonesia’s National Cardiac Center Harapan Kita. Method This is a single-center retrospective cohort study conducted to evaluate the incidence of MACE, rehospitalization, and mid term mortality in ASD-PH patients who have undergone ASD surgical closure. Data collection was conducted to an end point of 30 June 2024, except if the patient experiences mortality. ASD-PH patients that have undergone surgical closure in the Indonesian National Cardiac Center Harapan Kita are categorized into Low and Borderline preoperative PVRi groups. Telephone conversations with patient guardians and medical record studies were conducted to determine midterm incidence of Mortality, Major Adverse Cardiovascular Events (MACE) and rehospitalization following surgical closure. Results A total 180 patients that were successfully discharged from the hospital following ASD surgical closure from 2014-2019 in the Indonesian National Cardiac Center Harapan Kita are included in this study; with a follow up period of 2433 (± SD 507). As many as 3 patients were not able to undergo the follow up period, such that a total 180 patients are included in this study’s analysis, of whom 89 are categorized as Low preoperative PVRi and 91 are part of the borderline preoperative PVRi group. There was no significant association found between borderline preoperative PVRi to increased risk of postoperative incidence of mortality (p=0.574) and MACE (p=0.08), but there is a significant association to incidence of rehospitalization (p=0.019) for the mid term follow up period. Multivariate analysis shows that patients with older age >40 years old (p value=0.004, OR=17.946), and bidirectional shunt (p value=0.024, OR=3.459) are significantly associated with risk of mid term incidence of MACE. Conclusion Incidence of mortality and mid term MACE in borderline PVRi ASD-PH patients are not significantly different to that found in the Low PVRi ASD-PH group, but incidence of rehospitalization in the borderline PVRi group is higher compared to the Low PVRi group. Older age >40 years old and bidirectional shunts increase risk of midterm rehospitalization in ASD-PH patients in the borderline PVRi group. There is no significant difference in midterm mortality and MACE between Borderline and Low preoperative PVRi patients, however, Borderline PVRi and patients with preoperative Bidirectional shunts patients have significantly higher incidence of postoperative rehospitalization compared to Low PVRi patients. Older age is associated with midterm MACE.
Keywords: Atrial Septal Defect (ASD), Pulmonary Hypertension (PH), Pulmonary Vascular Resistance Index (PVRI), ASD Surgical Closure, Mortality, MACE, Rehospitalization


Latar Belakang Dengan ditetapkannya tingkat Indeks Resistensi Vaskular Pulmonal (PVRi) sebagai salah satu faktor penentu utama untuk kelayakan operabilitas pada pasien ASD-PH, studi ini bertujuan untuk membandingkan hasil pasca operasi jangka menengah pada pasien dengan PVRi Rendah dan Perbatasan (masing-masing, < 4 WU ·m2 dan 4-8 WU ·m2) di demografi pasien unik di Pusat Jantung Nasional Harapan Kita, Indonesia. Metode Studi ini adalah studi kohort retrospektif follow-up untuk menilai kejadian MACE, rehospitalisasi, dan mortalitas jangka mengengah pada pasien ASD PH yang telah dilakukan operasi penutupan ASD dilakukan secara bedah. Pengambilan data diambil sampai titik 30 Juni 2024, kecuali pasien mengalami mortalitas. Pasien ASD-PH yang telah menjalani penutupan bedah di RS jantung dan pembuluh Darah Harapan Kita dikategorikan menjadi kelompok PVRi rendah dan borderline. Follow up dilakukan dengan menggunakan percakapan telepon dengan wali pasien dan studi rekam medis untuk menentukan luaran MACE, rehospitalisasi dan mortalitas jangka menengah. Hasil Terdapat 180 pasien ASD-PH yang keluar hidup setelah dilakukan operasi penutupan ASD periode 2014-2019 di RS Jantung Harapan Kita yang diikutsertakan dalam FU studi ini; Lama pengamatan 2433 (± SD 507), sebanyak 3 orang tidak dapat dilakukan FU, sehingga 180 orang yang akan dimasukkan dalam analisis, yang terdiri dari 89 dengan PVRi preoperatif rendah dan 91 dengan PVRi preoperatif borderline. Tidak ditemukan hubungan bermakna antara PVRi preoperatif borderline dengan peningkatan risiko mortalitas pasca operasi (p=0.574). dan MACE (p=0.08), tetapi mempunyai hubungan bermakna dengan peningkatan risiko perawatan ulang (p=0.019) selama periode FU jangka menengah. Analisis multivariat menunjukkan bahwa pasien dengan usia tua >40 tahun (nilai p=0.004, OR=17.946), dan arah pirau bidireksional (nilai p=0.014, OR=3.459) secara bermakna meningkatkan risiko terjadinya MACE jangka menengah. Kesimpulan Angka mortalitas dan kejadian MACE jangka menengah pasien ASD PH borderline tidak berbeda bermakna dengan kelompok ASD PH ringan tetapi angka rehospitalisasi pada kelompok ASD PH borderline lebih tinggi dibandingkan dengan kelompok PH ringan. Usia>40 tahun dan arah pirau bidireksional meningkatkan risiko rehospitalisasi jangka menengah pasien ASD PH pada kelompok borderline.
Kata Kunci: Defek Septum Atrium (ASD), Hipertensi Pulmonal (PH), Indeks Resistensi Vaskular Pulmonal (PVRi), Penutupan Bedah ASD, Mortalitas, MACE, Rawat Inap Kembali