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"Latar belakang : Selama beberapa dekade terakhir, popularitas operasi katup mitral dengan metode minimal invasif (MI) telah berkembang. Tujuan dari penelitian ini adalah untuk membandingkan metode operasi minimal invasif dan konvensional. Banyak penelitian menunjukkan keuntungan penggunaan metode minimal invasif, seperti mengurangi rasa sakit pasca-operasi, mempercepat waktu pemulihan pasca-operasi, antara lain durasi lama rawat di ICU, durasi total lama perawatan di rumah sakit. Untuk itu diperlukan suatu penelitian untuk mengetahui luaran antara metode operasi minimal invasif dan konvensional pada kasus pembedahan katup mitral.Metode : Desain penelitian ini adalah potong lintang komparatif, membandingkan luaran teknik operasi minimal invasif dengan konvensional. Luaran yang diamati adalah lama rawat pasca-operasi, antara lain durasi lama rawat di ICU dan durasi total lama perawatan di rumah sakit, skor nyeri pasca operasi, jumlah perdarahan, dan lama durasi klem silang aorta dan CPB.Hasil : Distribusi usia pada kelompok minimal invasif antara 40-49 tahun, sedangkan pada kelompok konvensional antara 50-59 tahun. Jenis kelamin lebih didominasi oleh laki-laki. Rata-rata durasi cross klem (AOX) pada kelompok minimal invasif 99.85 menit, sedangkan durasi CPB 133.87 menit. Rata-rata waktu cross klem (AOX) kelompok konvensional 89.49 menit dan durasi CPB 112.62 menit. Berdasarkan statistik penelitian sebelumnya, tidak ada perbedaan penggunaan AOX pada kedua kelompok yang dibandingkan (p =0.145). Pada minimal invasif diperoleh 40 subjek dengan NYHA functional class III dan 16 subjek dengan NYHA functional class IV, sedangkan pada kelompok konvensional diperoleh 35 subjek dengan NYHA functional class III dan 12 subjek dengan NYHA functional class IV. Pada data penelitian ini terdapat 11 subjek (10.7%) yang mempunyai EF kurang dari 55%, sedangkan sisanya (89.3%) EF dalam keadaan normal (55-80%). Pada kelompok minimal invasif rata-rata jumlah perdarahan intra-operatif adalah 273 cc, sedangkan pada kelompok konvensional 660 cc. Rata-rata lama penggunaan intubasi pada minimal invasif adalah 25,34 jam, sedangkan pada konvensional 42,87 jam. Rata-rata lama penggunaan drain pada minimal invasif adalah 2,68 hari, sedangkan pada konvensional 3 hari. Rata-rata lama rawat di ICU pada minimal invasive 1,36 hari, sedangkan pada konvensional 2,96 hari. Dari data statistik ini rerata perawatan di ICU ini memiliki perbedaan yang bermakna/strongly significant (p<0.05). Nyeri pasca-operasi pada minimal invasiv rata-rata pada VAS skala 4, sedangkan pada konvensional pada skala VAS 6-7.. Rata-rata panjang insisi operasi pada minimal invasif 4 cm dan konvensional 12 cm. Rata-rata lama rawat total di rumah sakit pada minimal invasif 6,68 hari, sedangkan pada konvensional 8,91 hari.Simpulan : Secara keseluruhan, metode minimal invasif lebih superior daripada metode konvensional, kecuali pada durasi penggunaan CPB.

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Background: Over the last decade, Minimally Invasive (MI) mitral valve surgery has grown in popularity. The purpose of this study was to compare the minimally invasive and conventional surgery. Many studies showed minimally invasive mitral valve surgery appeared to offer certain advantages, such as reduced postoperative pain and faster postoperative recovery time, which is faster ICU stay and hospitalize duration. This required a study to determine the output of the surgery between minimally invasive and conventional for the case of mitral valve surgery.

Methods: The study design was comparative cross-sectional, comparing the output of minimally invasive surgery with conventional techniques. The output were postoperative recovery time, such as ICU and hospitalize length of stay, postoperative pain scores, amount of bleeding, duration of aortic cross clamp and cardiopulmonary bypass time.

Results: The range of age in minimally invasive group was between 40-49 years old, whereas the conventional group was between 50-59 years old. Sex was dominant male. The mean time of cross clamp (AOX) in minimally invasive group was 99.85 minutes, whereas CPB time was 133.87 minutes. The mean time cross clamp (AOX) in conventional technique group was 89.49 minutes, whereas CPB time was 112.62 minutes. Based on previous statistic study, there was no differences were obtained in AOX time (p = 0.145). In minimally invasive group, there were 40 subjects with NYHA functional class III and 16 subjects with NYHA functional class IV, whereas in conventional technique group there were 35 subjects with NYHA functional class III and 12 subjects with NYHA functional class IV. There were 11 subjects (10.7%) with EF less than 55%, whereas 89.3% subjects with normal EF (55-80%). In minimally invasive group, the mean intra-operative bleeding was 273 cc, whereas in the conventional was 660 cc. The mean length of a minimal invasive intubation was 25.34 hours, whereas the conventional technique group was 42.87 hours. The mean duration of the using of drain in minimally invasive group was 2.68 days, whereas the conventional was 3 days. The mean of the length of ICU stay in minimally invasive was 1.36 days, whereas the conventional was 2.96 days. Based on statistic result, there was a meaningful/statistically significant on the mean of the length of stay in the ICU (p <0.05). The mean postoperative pain in minimally invasive group was on VAS scale 4, whereas in conventional group was on VAS scale 6-7. The mean of length incision on invasive surgery group was 4 cm and 12 cm in conventional group. The mean of length of stay in hospital in minimal invasive group was 6.68 days, whereas the conventional group was 8.91 days.

Conclusion: Overall, minimally invasive method was superior compared to conventional technique, except on the length of duration CPB use."

"Cedera iskemik reperfusi merupakan suatu kondisi yg sering dijumpai, dan dapat menyebabkan gangguan secara sitemik pada organ tubuh. Antara lain dapat menyebabkan kerusakan ke jaringan hepar secara remote.Tujuan: Mengetahui manfaat perlakuan prekondisi iskemik dan hipotermia pada cedera iskemik reperfusi tungkai bawah guna mencegah terjadinya kerusakan pada jaringan hepar.Metode. Dilakukan penelitian eksperimental pada kelinci New Zealand White (n=18) dengan satu kelompok kontrol (iskemia) dan dua kelompok perlakuan (hipotermia dan prekondisi iskemik). Dilakukan ligasi a. iliaca communis selama 4 jam, hipotermia (28oC), dan prekondisi iskemia pada masing-masing kelompok. Kemudian ligasi dilepas untuk reperfusi selama 8 jam. Lalu kelinci di euthanasia, jaringan hepar diambil untuk pemeriksaan histopatologi (Skoring penelitian).Hasil: Terdapat kerusakan jaringan hepar yang dinilai secara histopatologi sebagai efek cedera iskemik reperfusi jauh yang di akibatkan oleh iskemik tungkai akut pada hewan coba kelinci. Dengan melakukan skoring terhadap sel hepatosit, sitoplasma, sinusoid, batas interselular, mikrohemoragik, dan infiltrasi leukosit. Skor kelompok kontrol dengan median 89,50 min-max 75-91, Kelompok perlakuan IPC mean 49,17, SD 15,53. Kelompok perlakuan hipotermia mean 42,83 SD 22,02. Prekondisi iskemik dan hipotermia dapat mengurangi terjadi kerusakan jauh pada hepar secara bermakna dengan nilai p=0,002 dan p=0,004.Simpulan: Terbukti terjadinya kerusakan remote iskemik reperfusi pada hepar akibat cedera iskemik reperfusi tungkai akut, Hipotermia dan iskemik prekondisi secara signifikan dapat mengurangi terjadinya kerusakan itu.

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Background: ischemic reperfusion injury is a common condition that may disrupt systemic organs, especially causing liver damage remotely.

Objectives: to evaluate the benefit of ischemic preconditioning and hypothermia on ischemic reperfusion injury of the lower limbs from liver tissue damage.

Methods: this experimental study was performed using New Zealand White Rabbits (n=18) that were grouped into control group (ischemia) and treatment group (ischemic preconditioning and hypothermia). Iliaca communis artery was ligated for 4 hours and treated group had topical cooling until 28oC and performed ischmeic preconditioning. The ligation was released for reperfusion for 8 hours. The rabbits were then euthanized and liver tissue was taken for histopathologic examination.

Result: liver tissue damage was found histopathologically caused by remote ischemic reperfusion of rabbit limbs. By performing scoring of hepatocyte cells, cytoplasm, sinusioids, intercellular cells, microhemorrhage, and leucocyte infiltration. The median score for control group was 89.50 (ranged 75-91), and 49.17 for IPC group (SD 15.53).mean score for hypothermia group is 42.83 (SD 22.02). IPC and hypothermia showed to reduce liver damage significantly (p = 0.002 and p = 0.004)."

"Latar Belakang : Iskemia yang terjadi di suatu lokasi di tubuh mengakibatkan kerusakan pada lokasi yang berjauhan yang dikenal dengan sebutan cedera remote reperfusi. Paru merupakan salah satu organ target utama terjadinya kerusakan pada cedera remote reperfusi. Penelitian ini bertujuan melihat efek protektif hipotermia dan ischemic preconditioning (IPC) terhadap cedera remote reperfusi di paru.Metode : Dilakukan penelitian eksperimental pada kelinci New Zealand White (n=18) dengan satu kelompok kontrol (iskemia) dan dua kelompok perlakuan (preconditioning dan hipotermia). Dilakukan ligasi a. iliaca communis kanan selama 4 jam, hipotermia sedang (28oC), dan iskemia pre-conditioning pada masing-masing kelompok. Kemudian kelinci dibiarkan hidup selama 8 jam. Sampel jaringan paru di ambil untuk pemeriksaan derajat kerusakan paru secara histopatologi.Hasil : Terdapat perbedaan bermakna derajat perubahan histopatologik jaringan paru yang di berikan perlakuan IPC (p : 0,000) dan perlakuan Hipotermi (p : 0,015) terhadap kelompok kontrol.Kesimpulan : Ischemic preconditioning dan Hipotermi memberikan efek protektif pada paru dari akibat iskemik reperfusi tungkai bawah akut.

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Introduction. Acute lower limb ischemia may induced ischemia reperfusion injury to the lung and also initiate a systemic inflammatory response syndrome. The aim of this study was to proofed whether IPC and hypothermia of the limb before I/R injury would also attenuates the acute lung injury in rabbit model of hind limb I/R.

Method. This prospective, randomized, controlled, experimental animal study was performed in a university-based animal research facility with 18 New Zealand White Rabbit. The rabbits were randomized (n=6 per group) into three groups: I/R group (4 hours of hind limb ischemia and 8 hours of reperfusion), IPC group (three cycles of 5 minutes of ischemia/5 minutes of reperfusion immediately preceding I/R), and hypothermia ( 28oC) together with 4 hours of hind limb ischemia and 8 hours of reperfusion. Lung tissue were examined based for their histopathological changes. The changes were assessed based on the grading as normal, mild, moderate, and severe damage.

Result. Rabbit treated with IPC (p : 0,001) and hypothermia (p : 0,015) have demonstrated a significant decrease in histopathological features of acute lung reperfusion injury.

Conclusion. Ischemic preconditioning and hypothermia have shown protective effect for the lung from remote ischemic reperfusion injury induced by lower limb ischemia."

"Latar Belakang: Saat ini masih terdapat perdebatan mengenai usia terbaik untuk dilakukan koreksi total pada tetralogi Fallot (TF). Koreksi lebih dini mempunyai keuntungan serta kerugian. Koreksi total TF saat usia yang terlambat dapat mengakibatkan disfungsi ventrikel kanan dan terkadang disfungsi ventrikel kiri. Parameter disfungsi ventrikel yaitu TAPSE, MPI, franksi ejeksi. Tujuan: Untuk mengevaluasi durasi QRS, TAPSE, dan lama rawat ICU pasien TF yang dilakukan koreksi total ≤ 3 tahun lebih panjang dibandingkan koreksi total pada usia > 3 tahun. Metode: Studi kohort retrospektif pada subjek pasien anak dan dewasa yang menjalani koreksi total, minimum pemantauan 6 bulan pasca-koreksi total. Analisis data menggunakan Mann Whitney U Test serta uji Chi square. Hasil: Sebanyak 358 pasien TF telah menjalani koreksi total sejak 1 januari 2007 sampai 31 Juni 2013 dan sebanyak 52 subjek (18 subjek pada usia koreksi < 3 tahun dan 34 subjek dengan usia koreksi > 3 tahun) dengan median rentang lama pemantauan 24,5 dan 30 bulan. Rentang usia pada kelompok koreksi ≤ 3 tahun 1,8 (0,7-3) tahun dan kelompok koreksi > 3 tahun 5,2 (3,1-25,5) tahun. Rerata waktu PJP 79,1 (27,5) menit dibanding 78,8 (28,7) menit dan rerata aortic cross clamp 35,6 (13,2) dibanding 34,7 (19,1) menit tidak bermakna pada kedua kelompok. Penggunaan ventilator dengan median 1 hari, penggunaan chest tube dengan median 3 hari, lama penggunaan inotropik dengan median 2 hari tidak berbeda pada kedua kelompok. Terdapat abnormalistas rerata pengukuran RVMPI dan LVMPI pada kedua kelompok. Sebagian besar terdapat gangguan irama berupa complete RBBB, dan sekitar 50% didapatkan regurgitasi tricuspid. Residual stenosis pulmonal didapatkan pada 3/34 dan residual DSV pada 2/34 subjek pada koreksi > 3 tahun. Median lama rawat ICU [2 (1-9) hari dibanding 1,5 (1-46) hari, p=0,016] serta median durasi QRS [118 (78-140) ms dibanding 136 (80-190) ms, p=0,039] berbeda bermakna pada kedua kelompok, sedangkan tidak terdapat hubungan antara TAPSE dengan usia koreksi dengan RR 0,85; IK 95% 0,26-2,79 p=0,798. Simpulan: Pasien TF yang dilakukan koreksi total ≤ 3 tahun memiliki durasi QRS lebih pendek, TAPSE yang tidak lebih baik dibandingkan dengan koreksi > 3 tahun, dan waktu rawat ICU lebih panjang.

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Background: Timing for correction in patients with tetralogy of Fallot (TF) is controversial. Repair at < 3 years old shows good myocardial performance. Late repair can shows prolonged QRS duration, ventricular dysfunction with parameters myocardial performance index (MPI) and TAPSE, but longer intensive care unit (ICU) stays.

Aims: To evaluate QRS duration, right ventricle function measured by TAPSE, ICU length of stays (LOS) of patients after correction TF which is repaired in age ≤ 3 versus > 3 years old.

Methods: Cohort retrospective study was performed in children and adults who were underwent correction with minimal follow up was 6 months. The TAPSE and QRS duration was evaluated during follow up. We compared using Mann Whitney U test and Chi square test analyses.

Results: Among 358 children recruited, there were 52 subject completed the study, 18 in correction age ≤ 3 years old group and 34 at age > 3 years old group who underwent total correction since January 2007 – June 2013. Age when underwent total correction ranging from 7 months – 25 years old, with follow up data was took at 24-30 months after discharge. There were abnormalities at right ventricle and left ventricle MPI, but weren’t different between groups. There were a significant difference between ICU LOS [2 (1-9) days vs. 1.5 (1-46) days p=0.016] and QRS durations [118 (78-140) ms vs 136 (80-190) ms, p=0.039]. Aged repaired didn’t increase risk of having abnormality TAPSE (RR 0.85; 95% CI 0.26-2.79; p = 0.798).

Conclusion: TF total correction at ≤ 3 years old has shorter QRSdurations at follow up and longer ICU LOS. Correction at > 3 years old didn’t proven as a risk to have abnormality TAPSE."

"ABSTRAKPendahuluan Keputusan untuk melakukan tindakan operasi reparasi dan replace katup mitral pada stenosis mitral masih diperdebatkan. Tujuan penelitian ini adalah mencari hubunganantara Wilkin?s score dengan keputusan operasi reparasi dan replace katup mitralpada stenosis mitral, serta mencari titik potong nilai Wilkins? score pada operasireparasi dan replace katup mitralMetodePenelitian adalah deskriptif analitik dengan pendekatan cross sectional secararetrospektif mencakup seluruh pasien dari RS Harapan Kita Jakarta yang dilakukanoperasi stenosis mitral pada Januari 2010 ? September 2015 oleh satu orang dokterbedah Jantung. Hubungan Wilkins? score dengan keputusan operasi serta nilai titikpotong Wilkins? score pada operasi reparasi dan replace menjadi luaran yang akanditeliti.HasilSeratus dua puluh lima subjek dengan usia rata-rata kelompok reparasi 36,78 ± 9,37tahun dan replace 44,49 ± 9,29 tahun. Didapatkan nilai mean Wilkins? score padakelompok reparasi 6,5 (4-12) dan kelompok replace 8 (4-14) dengan nilai signifikansip<0,001. Dengan area under curve 0,786 dan p<0,001, dapat dinilai titik potongWilkins? score berada pada nilai 7. Dengan memerhatikan variabel lain yangmenunjukkan adanya hubungan signifikan pada analisis bivariat yaitu usia,regurgitasi mitral dan Euro score, dilakukan analisis multivariate dengan uji regresilogistic didapatkan area under curve 0,946 dan p<0,001, dapat dinilai titik potongWilkins? score berada pada 5. KesimpulanWilkins? score berhubungan dalam pengambilan keputusan tindakan operasi reparasidan replace katup pada subjek dengan stenosis mitral, dengan titik poin pada putusanoperasi reparasi dan replace yaitu Wilkins? score 7. Jika Wilkins? scoremempertimbangkan faktor usia, regurgitasi mitral dan Euro score titik poin padaputusan operasi reparasi dan replace yaitu Wilkins? score 5.

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ABSTRACTIntroductionDecision on the repair and replacement of mitral valve surgery in mitral stenosispatients is still being debated. The aim for this research is to find the relationshipbetween Wilkins? score and the decision between repair and replacing mitral valve inmitral stenosis cases, and to find the cut off point for Wilkins?score in the mitralvalve repair and replacement procedureMethodsThe research is an analytic descriptive study with restrospective cross sectionaldesign. This research covered all patients of Harapan Kita Hospital for Heart andBlood vessels that had mitral stenosis operations from January of 2010 untilSeptember 2015 that is conducted by one of the surgeon in that hospital. Therelationship between Wilkin?s score and the decision to operate and the cut of pointof the Wilkins? score on the repair and replacement decision is the outcome that weare going to study in this research.ResultsOne hundred and twenty five subjects with the mean age of repair 36,78 ± 9,37 yearsold and replacement age of 44,49 ± 9,29 years old. We found that the mean ofWilkins? score in the reparation group is 6,5 (4-12) and in the replacement group is 8(4-14) with the significance value is p <0,001. With area under the curve of 0,786 andp<0,001 we can see that the the cut off point for Wilkins? score is 7. By seeing othervariables to show the significance between all bivariates variable such as age, mitralregurgitation and Euro score, we conducted multivariate analysis of regression testwe found area under the curve 0,946 with p<0,001. We can assess that the cut offpoint of Wilkins? score is 5 ConclusionWilkins score is related with decision making of valve repair and replacmentprocedure in patients with mitral stenosis with poin between decision is 7. If Wilkinsscore consider other factors such as age, the presence of mitral regurgitation and EuroScore the point that determine the decision to repair and replace mitral valve isWilkins? score 5."

"ABSTRAKTujuanPenelitian mengenai penggunaan analisis faktor risiko dan mortalitas pada operasijantung masih menjadi perdebatan dan merupakan area yang sedang berkembang.Analisis faktor risiko dalam penilaian suatu hasil pembedahan jantung merupakan halyang tidak dapat dihindari. Ahli bedah dan rumah sakit memerlukan suatu hasilpenilaian faktor risiko terhadap risiko kejadian mortalitas perioperasi agar dapatmenentukan keputusan klinis. Tujuan penelitian ini adalah untuk membandingkanParsonnet dan European System for Cardiac Operative Risk Evaluation (EuroSCORE)pada pasien yang menjalani perbaikan katup mitral dan memperkirakan faktor-faktorrisiko apa saja yang dapat mempengaruhi mortalitas perioperatif.Pasien dan MetodeDari bulan Januari 2010 sampai dengan bulan Desember 2012, 96 pasien terpilih yangtelah menjalani operasi perbaikan katup mitral menggunakan mesin jantung paru dantelah dilakukan analisis faktor risiko berdasarkan Parsonnet score and EuroSCORE .seluruh faktor risiko dianalisis dengan analisis deskriptif, tabulasi silang, Pearson ChiSquare, dan uji Anova, keduanya juga dianalisis dengan kurva ROCHasilAngka mortalitas riil sebesar 5,2 %. Berdasarkan Parsonnet score, nilai prediksimortalitas sebesar 18,26 % sementara pada EuroSCORE nilai prediksi mortalitassebesar 3,68 %. Hasil keduanya signifikan secara statistik. Nilai prediksi EuroSCORElebih mendekati angka kematian riil bila dibandingkan Parsonnet score .KesimpulanEuroSCORE lebih unggul dibandingkan dengan Parsonnet score .Nilai prediksiEuroSCORE lebih mendekati angka kematian riil . EuroSCORE merupakan alat ukuryang baik dalam analisis faktor risiko dan mortalitas pada operasi perbaikan katupmitral

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ABSTRACTObjectiveThe use of risk stratified mortality studies for analyzing surgical outcome in cardiacsurgery is obviously a developing area. Unfortunately, outcomes research in valverepair surgery has been relatively limited. The risk stratification in the assessment ofcardiac surgical results is inevitable. Surgeons and hospitals need availability of riskassessment result which may influence decision-making. Without risk stratification,surgeons and hospitals treating high-risk patients will appear to have worse resultsthan others. Our purpose was to compare the performance of risk stratification models,Parsonnet and European System for Cardiac Operative Risk Evaluation (EuroSCORE)in our patients undergoing mitral valve repair (MVr) and predict the risk factors thatinfluence inhospital mortality .Patient and methodsFrom January 2010 to December 2012, 96 consecutive patients have undergone MVrusing cardiopulmonary bypass and scored according to Parsonnet score andEuroSCORE algorithm. All risk factors were analyzed by descriptive analytic, crosstabulation, Pearson Chi Square, and Anova test, both scores analyzed by ROC curve.ResultsOverall hospital mortality was 5,2 %. In Parsonnet model, predicted mortality was18,26 % while in the EuroSCORE model, predicted mortality was 3,68 %. and it wasstatistically significant for the Parsonnet score and EURO score . Parsonnet Score hasa higher sensitivity compared to the EuroSCORE. From the ROC curve, AUC forParsonnet score (0,905) higher than AUC for EuroSCORE (0,892). Problems with theParsonnet score of subjectivity, inclusion of many items not associated with mortality,and the overprediction of mortality have been highlighted. Pre operative NYHA class,age, ejection fraction , complication, etiology, EuroSCORE, and Parsonnet scoreduring mitral valve repair were statistically significant for affecting inhospitalmortality risk.ConclusionsThe EuroSCORE is more reasonable overall predictor of hospital mortality in ourpatients undergoing MVr compared to Parsonnet score."

"ABSTRAKLatar belakang: Beberapa komplikasi sulit yang timbul setelah tindakan sternotomi mediana yang menjadi penyebab utama mortalitas dan morbiditas pasien. Hal ini dapat dicegah dengan aproksimasi sternum yang stabil, Berbagai macam teknik jahitan fiksasi untuk aproksimasi sternum menggunakan wire. Peneliitian ini membandingkan biomekanik teknik jahitan figure of eight trans-sternal dan peristernal. Metode: Penelitian eksperimental pada sternum kambing sebanyak 36 sampel, dilakukan sternotomi mediana, kemudian dilakukan fiksasi sternum menggunakan wire, 18 sampel dilakukan fiksasi jahitan figure of eight peristernal dan 18 sampel trans-sternal. Dinilai dengan uji komparasi tiga dimensi: lateral distraction, transversal shear dan longitudianal shear dengan beban 125N, 150N, 200N, 250N, 300N, 400N. pergeseran diukur dalam mm setiap tingkat pembebanan. Dilakukan analisis statistik dengan uji independent sample t-test. Hasil: Pada uji lateral distraction dan longitudinal shear didapatkan perbedaan bermakna pada pemberian beban ringan 125N, 150N dan 200N, pada beban 300N dan 400N tidak ada perbedaan bermakna. Uji transversal shear tidak ada perbedaan bermakna pada kedua teknik jahitan. Pada hasil uji tarik kedua teknik jahitan mengalami pergeseran lebih dari 2mm pada pembebanan 250 N. Kesimpulan: Stabilitas sternum pada teknik jahitan figure of eight peristernal sama dibanding jahitan figure of eight trans-sternal.

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ABSTRACTBackgrounds There are troublesome complications following median sternotomy which are lead to major causes of morbidity and mortality of patients. This can be prevented by stable sternal approximation, Various suturing fixation method for sternal approximation using wire. To compare the biomechanics of the figure of eight trans sternal and the peristernal suturing method. Methods Experimental study on goat sternum 36 samples, performed sternotomi mediana, then performed sternum fixation using wire, 18 samples performed suturing fixation of figure of eight peristernal and 18 sample trans sternal. Assessed by a three dimensional comparative test lateral distraction, transversal shear and longitanium shear with loads of 125N, 150N, 200N, 250N, 300N, 400N. Shifts are measured in mm at each loading level. Statistical analysis was performed using independent sample t test. Results In lateral distraction and longitudinal shear tests, there were significant differences in the loading of light loads of 125N, 150N and 200N. The transverse shear test no significant difference in the two suturing techniques, In the bending test results both suturing method experience a shift of more than 2mm at 250 N loading. No other significant differrences in clinical outcomes. Conclusions The sternal stability of the peristernal figure of eight method is the same as that of the trans sternal figure of eight."

"[ABSTRAKLatar belakang: Luaran pasca-bedah jantung penting diketahui untuk menilai kinerja pelayanan bedah jantung anak, sehingga kualitas pelayanan dapat ditingkatkan.Tujuan: Mengetahui luaran jangka pendek (mortalitas, komplikasi pasca-bedah berat lain, dan komplikasi pasca-bedah yang berat) pada anak yang dilakukan bedah jantung. Selain itu, ingin mengetahui faktor risiko terjadinya komplikasi berat pasca-bedah jantung dan membuat sistem skor dari faktor-faktor risiko tersebut.Metode: Setiap anak dengan penyakit jantung yang dilakukan operasi jantung di RSUPN Dr Cipto Mangunkusumo Jakarta sejak April 2014 sampai Maret 2015 diikuti setiap hari sampai pasien pulang atau meninggal. Data demografis, mortalitas, morbiditas atau komplikasi pasca-bedah jantung, dan faktor risiko terjadinya morbiditas pasca-operasi yang berat diambil dari rekam medis. Pasien yang sudah pulang dari rumah sakit, dalam waktu 30 hari pasca-operasi dihubungi untuk mendapatkan data kondisi pasien dalam waktu tersebut (hidup atau meninggal).Hasil: Selama penelitian didapatkan 258 anak dilakukan bedah jantung. PJB terbanyak yang dilakukan bedah jantung adalah ventricle septal defect (28,7%) dan tetralogy of Fallot (24,4%). Komplikasi pasca-bedah jantung terjadi pada 217 (84,1%) anak dan komplikasi berat terjadi pada 49 anak (19%). Komplikasi pasca-bedah jantung terbanyak adalah hipokalsemia pada 163 (63,2%) anak, hiperglikemia 159 (61,6%), low cardiac output syndrome 52 (20,2%), aritmia 48 (18,6%), sepsis 45 (17,4%), dan efusi pleura 39 (15,1%). Komplikasi berat meliputi in-hospital mortality terjadi pada 33 (12,7%) anak dan mortalitas dalam waktu 30 hari pasca-bedah jantung terjadi pada 35 (13,6%) anak, henti jantung 13 (5%), operasi jantung ulang 10 (3,9%), dan gagal organ multipel 19 (7,4%). Faktor risiko yang berhubungan dengan meningkatnya komplikasi pasca-bedah jantung yang berat adalah peningkatan kadar laktat darah [OR 30,7 (IK 95% 8,1-117,6)], PJB sianotik [OR 4,4 (IK 95% 1,2-15,8), dan pemakaian inotropik yang tinggi [OR 7,8 (IK 95% 1,6-38,9)]. Skor faktor risiko ≥ 3 mampu memprediksi anak yang mengalami komplikasi berat pasca-bedah jantung dengan sensitivitas skor 93,9% dan spesifisitas skor 84,2%, dan area di bawah kurva receiver operating characteristic (ROC) adalah 0,94.Simpulan: Mortalitas di rumah sakit pasca-bedah jantung anak sebesar 12,7% dan mortalitas 30 hari pasca-bedah 13,6%. Komplikasi berat lain pasca-bedah 13,6%. Faktor risiko yang berhubungan dengan meningkatnya komplikasi pasca-bedah jantung yang berat adalah peningkatan kadar laktat darah, PJB sianotik, dan pemakaian inotropik tinggi pasca-bedah jantung. Skor faktor risiko ≥ 3 mampu memprediksi anak yang mengalami komplikasi berat pasca-bedah jantung dengan sensitivitas skor 93,9% dan spesifisitas skor 84,2%.

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ABSTRACTBackground: Outcome of children with cardiac surgery is important to evaluate the performance of cardiac surgery program. Identifying the risk factors for major adverse events after cardiac surgery is also important to improve patient care.Objective: To evaluate the incidence of short-term outcome in children after cardiac surgery, including mortality, complication or morbidity, major complications, and the risk factors associated with major adverse events (major complications) at the Dr Cipto Mangunkusumo Hospital, Indonesia.Methods: A prospective observational study was conducted from April 2014 until March 2015. All children conducted cardiac surgery, were monitored from the time the cardiac surgery performed until patients were discharged or deceased. During the follow up of all recruited patients, factors associated with the risk of developing major adverse events were identified.Results: A total of 258 patients were recruited during the study period. Of the total, 134 (51.9%) were female. The mean age of the patients was 53.3±3.8 months. Among the patients, 217 (84.1%) had complications. The most complications occurred after cardiac surgery were hypocalcaemia in 163 (63.2%), hyperglycemia in 159 (61.6%), low cardiac output syndrome in 52 (20.2%), arrhythmia in 48 (18.6%), sepsis in 45 (17.4%), and pleural effusion in 39 (15.1%) children. Further, 49 (19%) of recruited patients had major adverse events (major complications), including in-hospital mortality in 33 (12.7%) and 30-day mortality in 35 (13.6%), cardiac arrest in 13 (5%), the need for re-operation in 10 (3.9%), and multiple organ failure in 19 (7.4%) children. Factors associated with the occurrence of major complications were increase in blood lactate [OR 30.7 (95% CI 8.1-117.6)], cyanotic congenital heart disease [OR 4.4 (95% CI 1.2-15.8), and high inotropes on leaving operating room [OR 7.8 (95% CI 1.6-38.9)]. Risk factor score ≥3 could predict major complications after cardiac surgery with sensitivity of 93.9% and specificity of 84.2%, and area under receiver operating characteristic (ROC) curve was 0.94.Conclusion: In-hospital mortality after paediatric cardiac surgery at Dr Cipto Mangunkusumo hospital is 12,7% and 30-day mortality is 13,6%. Increase in blood lactate, cyanotic congenital heart disease, and high inotropes on leaving operating room are associated with mortality and other major complications in children following cardiac surgery. Risk score ≥ 3 can predict the development of major complication in children after cardiac surgery with sensitivity 93,9% and specificity 84,2%.;Background: Outcome of children with cardiac surgery is important to evaluate the performance of cardiac surgery program. Identifying the risk factors for major adverse events after cardiac surgery is also important to improve patient care.Objective: To evaluate the incidence of short-term outcome in children after cardiac surgery, including mortality, complication or morbidity, major complications, and the risk factors associated with major adverse events (major complications) at the Dr Cipto Mangunkusumo Hospital, Indonesia.Methods: A prospective observational study was conducted from April 2014 until March 2015. All children conducted cardiac surgery, were monitored from the time the cardiac surgery performed until patients were discharged or deceased. During the follow up of all recruited patients, factors associated with the risk of developing major adverse events were identified.Results: A total of 258 patients were recruited during the study period. Of the total, 134 (51.9%) were female. The mean age of the patients was 53.3±3.8 months. Among the patients, 217 (84.1%) had complications. The most complications occurred after cardiac surgery were hypocalcaemia in 163 (63.2%), hyperglycemia in 159 (61.6%), low cardiac output syndrome in 52 (20.2%), arrhythmia in 48 (18.6%), sepsis in 45 (17.4%), and pleural effusion in 39 (15.1%) children. Further, 49 (19%) of recruited patients had major adverse events (major complications), including in-hospital mortality in 33 (12.7%) and 30-day mortality in 35 (13.6%), cardiac arrest in 13 (5%), the need for re-operation in 10 (3.9%), and multiple organ failure in 19 (7.4%) children. Factors associated with the occurrence of major complications were increase in blood lactate [OR 30.7 (95% CI 8.1-117.6)], cyanotic congenital heart disease [OR 4.4 (95% CI 1.2-15.8), and high inotropes on leaving operating room [OR 7.8 (95% CI 1.6-38.9)]. Risk factor score ≥3 could predict major complications after cardiac surgery with sensitivity of 93.9% and specificity of 84.2%, and area under receiver operating characteristic (ROC) curve was 0.94.Conclusion: In-hospital mortality after paediatric cardiac surgery at Dr Cipto Mangunkusumo hospital is 12,7% and 30-day mortality is 13,6%. Increase in blood lactate, cyanotic congenital heart disease, and high inotropes on leaving operating room are associated with mortality and other major complications in children following cardiac surgery. Risk score ≥ 3 can predict the development of major complication in children after cardiac surgery with sensitivity 93,9% and specificity 84,2%., Background: Outcome of children with cardiac surgery is important to evaluate the performance of cardiac surgery program. Identifying the risk factors for major adverse events after cardiac surgery is also important to improve patient care.Objective: To evaluate the incidence of short-term outcome in children after cardiac surgery, including mortality, complication or morbidity, major complications, and the risk factors associated with major adverse events (major complications) at the Dr Cipto Mangunkusumo Hospital, Indonesia.Methods: A prospective observational study was conducted from April 2014 until March 2015. All children conducted cardiac surgery, were monitored from the time the cardiac surgery performed until patients were discharged or deceased. During the follow up of all recruited patients, factors associated with the risk of developing major adverse events were identified.Results: A total of 258 patients were recruited during the study period. Of the total, 134 (51.9%) were female. The mean age of the patients was 53.3±3.8 months. Among the patients, 217 (84.1%) had complications. The most complications occurred after cardiac surgery were hypocalcaemia in 163 (63.2%), hyperglycemia in 159 (61.6%), low cardiac output syndrome in 52 (20.2%), arrhythmia in 48 (18.6%), sepsis in 45 (17.4%), and pleural effusion in 39 (15.1%) children. Further, 49 (19%) of recruited patients had major adverse events (major complications), including in-hospital mortality in 33 (12.7%) and 30-day mortality in 35 (13.6%), cardiac arrest in 13 (5%), the need for re-operation in 10 (3.9%), and multiple organ failure in 19 (7.4%) children. Factors associated with the occurrence of major complications were increase in blood lactate [OR 30.7 (95% CI 8.1-117.6)], cyanotic congenital heart disease [OR 4.4 (95% CI 1.2-15.8), and high inotropes on leaving operating room [OR 7.8 (95% CI 1.6-38.9)]. Risk factor score ≥3 could predict major complications after cardiac surgery with sensitivity of 93.9% and specificity of 84.2%, and area under receiver operating characteristic (ROC) curve was 0.94.Conclusion: In-hospital mortality after paediatric cardiac surgery at Dr Cipto Mangunkusumo hospital is 12,7% and 30-day mortality is 13,6%. Increase in blood lactate, cyanotic congenital heart disease, and high inotropes on leaving operating room are associated with mortality and other major complications in children following cardiac surgery. Risk score ≥ 3 can predict the development of major complication in children after cardiac surgery with sensitivity 93,9% and specificity 84,2%.]"