Indonesian Study: Triiodothyronine for Infants Less than 5 Months Undergoing Cardiopulmonary Bypass

Eva Miranda Marwali, Albert Lopolisa, Alvin A. Sani, Muhammad Rayhan, Poppy S. Roebiono, Dicky Fakhri, Nikolaus A. Haas, April Slee, Michael A. Portman

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1 Citation (Scopus)


This study evaluates the efficacy and safety of oral triiodothyronine on time to extubation for infants less than 5 months undergoing heart surgery in Indonesia, and primarily relates to patients in emerging programs with high malnutrition and mortality. In this randomized, double-blind, placebo-controlled trial, oral triiodothyronine (T3, Tetronine®) 1 μg/kg-body weight/dose or placebo (saccharum lactis) was administered via nasogastric tube every 6 h for 60 h to treatment group. A total of 120 patients were randomized into T3 (61 patients) and placebo (59 patients) groups. The majority of the patients had moderate to severe malnutrition (55.83%) with a high post-operative mortality rate of 23.3%. The T3 group showed significantly higher serum FT3 levels from 1 until 48 h post cross-clamp removal (p < 0.0001), lower incidence of low cardiac output syndrome at both 6 h (28 [45.9%] vs. 39 [66.1%] patients, p = 0.03, OR 2.3, 95% CI: 1.10–4.81) and 12 h after cross-clamp removal (25 [41.7%] vs. 36 [63.2%], p = 0.02, OR 2.40, 95% CI: 1.14–5.05). Although not statistically significant, the treatment group had shorter median (IQR) intubation time (2.59 [1.25–5.24] vs. 3.77 [1.28–6.64] days, p = 0.16, HR 1.36, 95% CI: 0.88–2.09)] and lower mortality (10 [16.4%] vs. 18 [30.5%], p = 0.07]. Patients with Aristotle score < 10.0 (low risk) receiving T3 had faster extubation than placebo patients (p = 0.021, HR of 1.90, 95% CI: 1.10–3.28) and were significantly less likely to require CPR or experience infection (p = 0.027, OR 8.56, 95% CI:0.99–73.9 and p = 0.022, OR 4.09 95% CI: 1.16–14.4, respectively). Oral T3 supplementation reduced overall incidence of low cardiac output syndrome and significantly reduced the time to extubation in low-risk patients. Therefore, prophylactic oral T3 administration may be beneficial in these patients. Trial Registration: NCT02222532.

Original languageEnglish
Pages (from-to)726-734
Number of pages9
JournalPediatric Cardiology
Issue number4
Publication statusAccepted/In press - 2021


  • Congenital open cardiac surgery
  • Low cardiac output
  • Time-to-extubation
  • Triiodothyronine


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