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All Journal Jurnal Kedokteran Brawijaya Journal of the Indonesian Medical Association : Majalah Kedokteran Indonesia Jurnal Sains dan Kesehatan
Hanafy, Dudy Arman
Divisi Bedah Jantung Dewasa, Rumah Sakit Jantung Dan Pembuluh Darah Harapan Kita, Jakarta, Indonesia
Agriculture, Biological Sciences & Forestry Biochemistry, Genetics & Molecular Biology Chemistry Education Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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Cardiovascular outcomes in high risk patients undergoing OPCAB surgery compared to Traditional CABG Suwatri, Widya Trianita; Hanafy, Dudy Arman; Sugisman, Sugisman
Jurnal Kedokteran Brawijaya Vol 31, No 4 (2021)
Publisher : Fakultas Kedokteran Universitas Brawijaya

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Abstract

 The benefit of coronary artery bypass graft (CABG) for coronary artery disease (CAD) with Ejection Fraction (EF) £30% and ischemic burden (IB) £10% is still debateable. The objective of this study is to analyze mortality and morbidity in patients with EF £30% and ischemic burden £10% undergoing OPCAB compared to traditional CABG (TCABG).  The retrospective analytic cohort study was performed using data from January 2015–November 2018 at National Cardiovascular Center Harapan Kita Jakarta, Indonesia. 109 patients were included. 35 patients undergoing OPCAB and 74 patients undergoing TCABG. The primary outcomes were mortality rate, morbidity rate, and length of stay. Arrhytmia is statistically lower in OPCAB compared to TCABG (8.6% vs 39.2%; p = 0.001). Kidney injury is statistically lower in OPCAB (8.6% vs 27.0 %; p = 0.027). Stroke is statistically lower in OPCAB (1.0 % vs 17.6%; p = 0,032). There is no significant difference between OPCAB and TCABG in mortality, 5.7% vs 16.2%, (RR 3.20; CI 95% 0.67–15.12; p = 0.126). There was a statistically significant difference in the occurrence of postoperative morbidity in CAD patients with EF < 30% and IB < 10% who underwent OPCAB surgery compared with patients who underwent TCABG. Mortality that occurred after OPCAB procedure was lower in CAD patients with EF < 30% and IB < 10% compared to TCABG although the statistical difference was not significant. Therefore, patients with this condition are more adviseable to undergo OPCAB. Keyword: left ventricular dysnfunction, ischemic burden, off-pump coronary artery bypass grafting
Analisis Biaya Operasi Teknik Off-pump CABG dibandingkan On-pump CABG Pasien BPJS Penyakit Jantung Koroner dengan Fungsi Jantung Buruk di Rumah Sakit Jantung Harapan Kita Aris Aris; Yusi Anggriani; Hanafy Dudy Arman; Yacob Ruru
Jurnal Sains dan Kesehatan Vol. 3 No. 2 (2021): J. Sains Kes.
Publisher : Fakultas Farmasi, Universitas Mulawarman, Samarinda, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25026/jsk.v3i2.440

Abstract

Coronary heart disease (CHD) is a heart disease that is mainly caused by narrowing of the coronary arteries due to atherosclerosis or spam or a combination of both. In CHD patients who continued therapy, coronary artery bypass surgery can be performed Off-pump CABG or On-pump CABG, with hearts function poorly with LEF < 30 % at risk and a higher complication which results in increased costs. The research is aimed to analyze the operating cost Off-pump CABG technique compared to the On-pump CABG technique in patients with BPJS coronary heart disease with poor heart function in Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita on period January – December 2015. Patient sample selection is done in the installation of medical records with the diagnosis of CHD undergoing coronary artery bypass surgery technique Off-pump CABG and On-pump CABG. Data retrieval costs of pre-operatives, peri-operatives, and post-operative. This research conducted prospectively. Data were analyzed using the Kolmogorov test, Mann Whitney test, and Kruskal Wallis test. Research results obtained from a total of 70 patients with each of the 35 patients who underwent Off-pump CABG and On-pump CABG. The average cost of technique operation Off-pump CABG amounted to Rp.85,812,864. The average cost of technique operation on-pump CABG amounted to Rp.105,480,363. Operation margin amounted to Rp. 19,667,499. Mann-Whitney test shows different averages with p-value=0,006, then there is a significant difference between the two groups. Comparison of the rates for the Ina-CBGs surgery techniques Off-pump CABG an average of Rp.141,747,683, different of Rp. 55,934,819. Of the rates for the Ina-CBGs surgery techniques on-pump CABG an average of Rp. 138,782,251, different of Rp. 33,301,888. Kruskal Wallis test shows a different averages with p-value=0,000, then there is a significant difference between the two groups. Operating cost Off-pump CABG technique is lower than of On-pump CABG surgery technique. Operating cost Off-pump CABG technique and On-pump CABG lower than tariff Ina-CBGs.
Efektivitas Pemberian Deksametason dalam Memengaruhi Durasi Perawatan di Rumah Sakit Pada Operasi Bedah Pintas Arteri Koroner Off Pump Putra, Rally Galang Pratama; Hanafy, Dudy Arman; Wartono, Dicky Aligheri; Busro, Pribadi Wiranda; Herlambang, Bagus
Majalah Kedokteran Indonesia Vol 71 No 6 (2021): Journal of The Indonesian Medical Association - Majalah Kedokteran Indonesia, Vo
Publisher : PENGURUS BESAR IKATAN DOKTER INDONESIA (PB IDI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47830/jinma-vol.71.6-2021-746

Abstract

Introduction: The off pump coronary artery bypass surgery (OPCAB) technique is expected to be able to eliminate the side effects and complications caused by the use of a cardiopulmonary bypass (CPB) machine. However, this technique is not completely free from side effects or complications. One of the effects that can be caused is an increase in the systemic inflammatory response, so that the duration of hospitalization becomes longer. This is aim of this study to conduct a study of the administration of dexamethasone for reduced the length of hospital stay in patients undergoing OPCAB surgery. Methods: This was an analytic observational study with sixty patients who underwent OPCAB surgery and were randomized to either dexamethasone or placebo groups of 30 people each. Clinical results were analyzed. Results: The length of stay in the dexamethasone group compared to the placebo group was consecutive (5 (5-8) days vs 6.5 (5-30) days; p=0.04) so that there was a significant difference. Other clinical outcomes in the dexamethasone group were better than the placebo group, in terms of duration of mechanical ventilation (p=0.03) and intensive care unit stay (p=0.03). There were significant differences in inflammatory markers between the two groups: interleukin-6 (p=0.0001), procalcitonin (p=0.0001), and C-reactive protein (p=0.0001) were lower in the dexamethasone group. Conclusion: Preoperative dexamethasone in patients undergoing off-pump coronary artery bypass is effective in reducing the length of hospital stay and controlling postoperative inflammatory reactions.
Co-Authors Aris Aris Bagus Herlambang Pribadi Wiranda Busro Putra, Rally Galang Pratama Sugisman, Sugisman Suwatri, Widya Trianita Wartono, Dicky Aligheri Yacob Ruru Yusi Anggriani