Postoperative; Dysfunction Following Cardiac Surgery Clinical Trial
Official title:
Oral Triiodothyronine for Children Undergoing Cardiopulmonary Bypass in Indonesia
A condition of decreased serum T3 level in children after cardiac surgery using cardiopulmonary bypass has been commonly recognized as euthyroid sick syndrome (ESS). This syndrome has been closely associated with low cardiac output syndrome after heart surgery. The unique characteristics of pediatric patients with congenital heart disease (CHD) in Indonesia have caused ESS to arise in the population even before surgical managements. Thyroid hormones increase cardiac function, respiration and diuresis. Increased myocardial function occurred through the improvement of mitochondrial effectiveness as the body energy source by utilizing effective energy substrates, lactate and pyruvate. Prevention of decreased serum thyroid hormones level by T3 supplementation could be clinically beneficial. Intravenous T3 unit dose is very expensive and inapplicable for daily use. In adult studies, oral T3 was found to be effective for the prevention of decreased serum T3 levels; similar study on pediatric population, however, has not been elucidated.
Methods:
The study was conducted at the cardiac paediatric cardiac intensive care unit of National
Cardiovascular Center Harapan Kita. It was performed on paediatric congenital heart disease
population who underwent open heart surgery with randomised, double-blind, controlled trial
design. All patients with congenital heart disease, 3 years old or less, were included.
Types of congenital heart disease suffered required subject to undergo surgery using
cardiopulmonary bypass machine with Aristotle score of 6-9. Surgery was aimed for
biventricular repair.
The sample size needed almost 200 patients with 50% is in the treatment group. This
calculation was based on 90% of patients will be extubated and expected hazard ratio of
corresponding treatment group is 1.7 with 5% alpha error and 20% beta error.
Patients were randomised using block randomisation procedure. The stratification factor will
be age at the time of recruitment: < 6 weeks old, 6 weeks - 5 months old, > 5 months - 3
years old. Randomization will occur on the day of surgery.
The placebo - saccharum lactis - OR oral T3 (Tetronine, Dalim Biotech Korea) with the dose
of 1 mcg per kg body weight were administered via nasogastric tube for every 6 hours
starting from the time of anaesthesia induction until 11 doses in total (60 hours after the
initial administration). Serial free T3 (FT3) and thyroid stimulating hormone (TSH)
measurement were performed starting from the induction of anaesthesia until patient's
discharge. Haemodynamics monitoring and echocardiography evaluation was conducted from day 1
to 3 after the surgery.
Statistical analysis:
Primary analysis will be performed using Cox Proportional Hazards for time to extubation
result, including terms for stratification factors (age, Aristotle score and nutrition
status). Patients will be included in analysis if they were randomised and received at least
one dose of study drug according to the principal of Intention-to-Treat (ITT).
;
Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Primary Purpose: Treatment
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