Aortic Surgery in indonesia. Beginning at more that 10 years ago, but the significant umber were showed during the last 2 year (year after Korean era). Pf Kay hyun park, from Seoul National University Bundang Hospital was a hero which helped me build this aortic centre.

1. Dicky A.Wartono ,MD
National Cardiac & Vascular Centre Harapan Kita ,Jakarta Indonesia
2014

3. National (2013)
Population
245.425.266 (4th
)
Area
1.904.569 km2 (15th
)
735.358 sq mil

4. National (2013)
Population
245.425.266 (4th
)
Area
1.904.569 km2 (15th
)
735.358 sq mil
Jakarta (2013)
Population
12.210.223
15.464/km2 (37.460/sq mil)
Area
7.641.51 km2
2.950.40 sq mil

5. National Cardiac & Vascular Centre Harapan Kita
Jakarta Indonesia 2014

6. NCC Harapan Kita Annual Reports 2013

7. PROBLEMS?
NCC Harapan Kita Annual Repor
NCC Harapan Kita Out Patient Vascular Clinics Data 2012-2013
NCC Harapan Kita Vascular Conference Data 2012-2013

8. *STRUCTURAL
*Financial support (insurance system)
*Non priorities cases
*FUNCTIONAL
*Lack of knowledge
*Lack of human resource (doctors, surgeons, nurses, perfusionist)
*Lack of facilities (hospital, OR, instrument, graft etc)
*Reveral system (personal / institutional)
*PATIENTS
*Lack of knowledge
*Financials
*High coverage area (distance)
*Cases Quality

9. *STRUCTURAL
*Financial support (insurance system)
*Non priorities cases
*FUNCTIONAL
*Lack of knowledge
*Lack of human resource (doctors, surgeons, nurses, perfusionist)
*Lack of facilities (hospital, OR, instrument, graft etc)
*Reveral system (personal / institutional)
*PATIENTS
*Lack of knowledge
*Financials
*High coverage area (distance)
*Cases Quality
COVERAGE AREA
AORTIC / CV PATHOLOGY
Type 1 dissection w/axillary invl
Malperfusion
Rupture
Tamponade
Unstable HD
Dilated CMP
Redo Operation

11. *Median sternotomy / Laparotomy
*Cannulation sites :
*Axillary / Femoral Artery
*Right atrial / SVC & IVC
*Myocardial Protection :
*Antegrade CPG (Osteal)
*Retrograde CPG
*Surface cooling
*LV venting
*Organ / Brain Protection :
*DHCA
*ASCP / RSCP
*External cooling

12. Mortality (12/34, 35-36%)
Total Arch Replacement + ET 18 7
Ascending Aortic Replacement 5 1
Bentall Operation 6 2
Abdominal Aortic Replacement 5 2 Rupture 2
Total 34 12
TAR + Bental
TAR + AVR
TAR + AV rep
TAR + CABG
TAR + CABG + AVR + MVr
Dissection 24
Aneurysm 5

13. Preoperative data
No. of patients 29
Mean age (years) 57.2 yo
Median age (years) 59.7 yo
Age range (years) 47 - 69 yo
Age >65 years 1
Sex (male/female) 15 / 14
Ventilated
preoperatively 2
Aortic arch involvement 23
Preoperative
complications
Myocardial ischemia 3
Pericardial
tamponade 2
Hemodynamic
instability 3
Acute stroke 2
Acute renal failure 1

14. Operative data
R Axillary Artery involv 23
Coronary artery
involvement 3
Type of cerebral
perfusion
Antegrade 16 97.4 min 22 - 202 min
Retrograde 3 20.1 min 15 - 22 min
Ante & Retro 10
DHCA 29 116.1 min 34 - 214 min
Temp 18 25
Aortic valve intervention 6 3 R / 3 r
Aortic root replacement 6
Operative time 446 min 256 - 773min
Cannulation sites
Axillary artery 5
Aortic arch 1
CFA 23
CPG Antegrade 16
Retrograde 3
A & Retrograde 10

15. POST OPERATIVE COMPLICATIONS
THORACIC ABDOMINAL
NO. PATIENT 29 5
INTRA OPERATIVE DEATH 3 (10.3%) 0
POST OPERATIVE
MORTALITY 7 (24.2%) 2 (40%)
STROKE 1 (3.44%)
REOPERATION 5
RENAL FAILURE 2 (6.88%) 1 (20%)
SEPSIS/MOF 3 (10.3%) 1 (20%)
TOTAL MORTALITY
10 (34.5%) /
12 (35.14%)
ICU STAY 4.6 d 2.2 d
HOSPITAL STAY 16.3 d 10.2 d

16. AAA repair
No Patient 3
Follow Up(3) 3 month
TA replacement
No Patient 19
Follow Up(9) 1 died (3 month)
2 TAR underwent TEVAR (6 month)
1 HAR had distal anast pseudo aneurysm (3 month)
1 Mod Bentall had a stroke (6month)
2 Mod Bentall (3month)
2 Asc Replacement (6month)

17. *Aortic Endovascular Surgery
*Hybrid Aortic Surgery (Hybrid OR)
*ThoracoAbdominal Aortic Surgery
*More Dedicated Team

18. *“First reveral” (personal reveral) is the best option
*Aortic surgery is a “dedicated team” surgery
*Team must consist “a political & functional” aspect of service
*“To educate” is very important
*Keep learning & fighting & optimistic