Sujatha Kesavan - Academia.edu (original) (raw)

Papers by Sujatha Kesavan

Research paper thumbnail of Surgical aortic valve replacement in octogenarians: results in patients who could be considered for transcatheter aortic valve implantation

Heart, Jun 1, 2009

Transcatheter aortic valve implantation (TAVI) is evolving as an alternative to surgical aortic v... more Transcatheter aortic valve implantation (TAVI) is evolving as an alternative to surgical aortic valve replacement (AVR) in octogenarians with symptomatic aortic stenosis who are considered at high risk for surgical mortality and morbidity. Most series of TAVI recipients compare clinical results against surgical risk scores that predict mortality and morbidity. Few data are available for actual surgical results in patients who might now be considered candidates for TAVI. We conducted a retrospective analysis of AVR results in octogenarians in our unit. All data relevant for the current process of selection into the TAVI programme were assessed by review of the patient notes. A subgroup of patients who would formally be considered for TAVI was created and their results were analysed separately. Results 298 patients aged 80 years or older underwent surgical AVR between 1996 and August 2008. Of those, 140 patients had AVR for aortic stenosis and 133 had AVR and bypass surgery for aortic stenosis and symptomatic coronary disease. Out of these groups, 82 (isolated AVR) and 85 (AVR plus coronary artery bypass grafting) had a logistic Euroscore greater than 10. Conclusions The scores used to predict surgical mortality overestimate the risk of the operation in octogenarians. However, registry results of TAVI programmes suggest similar results for high-risk patient cohorts. A direct comparison appears justified.

Research paper thumbnail of P.3. Basic Science, Sudden Death Risk Stratification and Ventricular Arrhythmias

Europace, Oct 1, 2005

The prognostic significance of ventricular arrhythmia and cardiac arrest (from any cause) occurri... more The prognostic significance of ventricular arrhythmia and cardiac arrest (from any cause) occurring during acute myocardial infarction was investigated in 500 consecutive admissions to our CCU. For survivors of these events VT, VF and cardiac arrest were all predictive of increased subsequent mortality, however the predictive value of VF and cardiac arrest is greater than VT. The excess risk is greatest early post infarct. Mortality rates at 1,6 and 12 months in patients with no arrhythmia were 12.2%, 17.7% and 21.6%. In patients who survived VF they were 28.1%(p=0.01), 34.4%(p=0.02) and 37.5%(p=0.04), for cardiac arrest 30%(p= 0.002), 35%(p=0.008) and 42.5%(p=0.003). There was a trend to lower mortality in the events that occurred in the first 24-48 hours but the difference was not significant. For instance the mortality rate at 12 months for early compared with later VF events was 33.3% vs 38.9%, and for cardiac arrest 40% vs 50%. Only VT demonstrated a significant difference between early and late events with VT on admission being less predictive of mortality at 1 year 12.2% vs 32.1%(p=0.04).

Research paper thumbnail of 14. Ventricular Fibrillation & Out-of-Hospital Cardiac Arrest

Europace, Oct 1, 2005

greater involvement of outflow and inflow tracts compared with RV apex and evidenced a lesser inv... more greater involvement of outflow and inflow tracts compared with RV apex and evidenced a lesser involvement of septal wall compared with free wall. In all patients concordance was noted between EA mapping results and non-invasive morphological-functional RV evaluation. Conclusions: voltage mapping appears to be a promising method to study ARVC.

Research paper thumbnail of The Incidence and Outcome of Ventricular Arrhythmia & Cardiac Arrest During MI

Europace, Oct 1, 2005

Introduction: The female gender is known to be more sensitive to drug-induced long QT and cardiac... more Introduction: The female gender is known to be more sensitive to drug-induced long QT and cardiac arrhythmia, based on clinical observations, experimental in vitro data, in isolated rabbit and dog Purkinje fibers, and also in vivo data in rabbits. However, to-date there has been no demonstration of a gender difference in vivo in dogs. As such, the aim of this study was to try and elucidate whether a gender difference is present in this species in vivo. This knowledge is important to drug safety evaluation since conventionally the male dog is the chosen sex for safety pharmacology studies. Methods and Results: We evaluated potential gender differences in the following variables in neuromuscular blocked, mechanically ventilated anesthetized dogs: ventricular repolarization (ECG lead II, QT and qtcv; right ventricular endocardial monophasic action potential (MAP), duration at 90% repolarization, (APD 90), spatial dispersion of the T wave (Tp-Te), instability of qtend (QT TI: total instability), occurrence of eads and/or tdps. These parameters were derived from continuous beat-to-beat recordings of ECG and MAP signals. 20 female and 18 male dogs were treated with dofetilide (0.05 mg/kg i.v. Infusion over 10 min). At baseline, no statistically significant gender difference was observed on the various parameters, whilst dofetilide infusion produced greater electrophysiological alterations in females than in males. The respective median maximum percentage changes from baseline in females versus males were: heart rate (+3% / +6%, ns), QT (+23% / +14%, p = 0.003), qtcv (+20% / +15%, p = 0.03) and APD90 (+26% / +17%, p = 0.006). Dofetilide tended to differently increase Tp-Te (+40% vs +23%, ns) and QT TI (+150% vs +104%), more in female than in male animals. Additionally, dofetilide infusion elicited more incidences of eads on the MAP signal in female than in male dogs (73% versus 48%). Furthermore, the ikr blocker dofetilide (0.05 mg/kg iv) combined with Iks blocker HMR1556 (0.5 mg/kg iv) elicited tdps in 3 out of 4 female dogs in our preliminary investigations. Conclusion: Similar to man, the present study suggests that the female gender may be a risk factor for drug-induced long QT. Indeed, since significant alterations in additional markers beyond QT interval itself appear to be more pronounced in female dogs and eads occur more frequently in this sex, female dogs could be more sensitive to induction of polymorphic ventricular tachycardia (tdp). As such, consideration should be given to incorporation of female dogs into standard cardiovascular safety evaluations, or at least be the chosen single sex for drug safety evaluation, since the use of males may potentially lead to an underestimate of the QT-related pro-arrhythmogenic risk of a new chemical entity.

Research paper thumbnail of Does Timing of VF & Cardiac Arrest During MI Alter its Predictive Value?

Europace, Oct 1, 2005

The prognostic significance of ventricular arrhythmia and cardiac arrest (from any cause) occurri... more The prognostic significance of ventricular arrhythmia and cardiac arrest (from any cause) occurring during acute myocardial infarction was investigated in 500 consecutive admissions to our CCU. For survivors of these events VT, VF and cardiac arrest were all predictive of increased subsequent mortality, however the predictive value of VF and cardiac arrest is greater than VT. The excess risk is greatest early post infarct. Mortality rates at 1,6 and 12 months in patients with no arrhythmia were 12.2%, 17.7% and 21.6%. In patients who survived VF they were 28.1%(p=0.01), 34.4%(p=0.02) and 37.5%(p=0.04), for cardiac arrest 30%(p= 0.002), 35%(p=0.008) and 42.5%(p=0.003). There was a trend to lower mortality in the events that occurred in the first 24-48 hours but the difference was not significant. For instance the mortality rate at 12 months for early compared with later VF events was 33.3% vs 38.9%, and for cardiac arrest 40% vs 50%. Only VT demonstrated a significant difference between early and late events with VT on admission being less predictive of mortality at 1 year 12.2% vs 32.1%(p=0.04).

Research paper thumbnail of 34 Comparison of PCI vs CABG in insulin treated and non-insulin treated diabetic patients in the cardia trial

Research paper thumbnail of Transcatheter aortic valve implantation for patients at high risk of surgical aortic valve replacement: initial experience

Research paper thumbnail of Techniques to aid the implementation of novel clinical information systems: A systematic review

International Journal of Surgery, Nov 1, 2013

Research paper thumbnail of Perivascular Fat Phenotyping Predicts Plaque Progression and Allows Detection of Unstable Plaque Using Coronary Computed Tomography Angiography

Research paper thumbnail of None Reviewer

ventricular outflow tract

Research paper thumbnail of Ventricular Outflow Tract

Research paper thumbnail of 097 Surgical aortic valve replacement in high risk octogenerians vs transcatheter aortic valve implantation

Heart, 2010

Introduction Transcatheter aortic valve implantation (TAVI) is considered to subject less immedia... more Introduction Transcatheter aortic valve implantation (TAVI) is considered to subject less immediate procedural risk than surgical aortic valve replacement (AVR) in high risk elderly patients. Therefore high risk Octogenarians are now being considered for TAVI in preference to AVR. The evidence for this strategy and methods for patient selection are not established. The use of the Logistic Euroscore (LES) in this context has been questioned. We have prospectively compared our TAVI patient characteristics and outcomes with retrospective analysis of high risk Octogenarians who underwent AVR. Methods The records of 273 patients aged 80 and over who underwent AVR at the Bristol Heart Institute between 1996 – 2008 were analysed. Patients with a Logistic Euroscore of 15 and above were identified as high risk including those that had concomitant bypass grafting. All TAVI procedures were performed with the Medtronic Corevalve system between Jan 2008 and Oct 2009. Data was collected prospectively as per the Central Cardiac Audit Database (CCAD) TAVI dataset and all patients were included for comparison. Results Abstract 097 Table 1 80 AVR patients and 41 TAVI procedures were identified. The median LES was 20.7 (average age 83.5, male 51.2%) and 16.4 (average age 83.9, male 48%) respectively. More TAVI patients had previous cardiac surgery (19.5% vs. 15%). The postoperative stroke rate was 4.8% in the TAVI group vs. 6% for AVR. The rate of pacemaker implantation was greater in the TAVI group (24.4% vs. 11%). Abstract 097 Table 1 Patient characteristics TAVI, n=41 AVR, n=80 PCI with TAVI (hybrid)/ CABG + AVR 19.5 54 Previous MI 17 36.25 Diabetic 9.8 4 Renal impairment 39 9 Pulmonary disease 26.8 33 Previous cardiac surgery 19.5 15 Neurological disease (CVA/TIA) 26.3 18 Peripheral vascular disease 26.3 16 EF < 30% 0 19 Logistic Euroscore (median) 16.4 20.7 Mortality rates were significantly lower in the TAVI group (30 day mortality 2.4% vs. 14%, 90 day mortality 2.4% vs. 19%). There was a shorter median postoperative recovery for the TAVI patients prior to discharge (7 days vs. 11 days) and more patients were discharged directly home to indepedence (90.2% vs. 44%). Conclusion In this historical, clinically selected group of Octogenarians the LES appears to correlate well with subsequent surgical risk of AVR. In our current cohort of high risk elderly patients undergoing TAVI there are comparatively lower mortality rates, shorter recovery times and earlier discharges home to independence. However, Corevalve patients are requiring more post-procedure permanent pacemakers. In elderly patients with symptomatic aortic stenosis it is appropriate to use LES as a factor to identify those who are likely to have a better outcome with TAVI compared to traditional AVR. Abstract 097 Table 2 Patient outcomes TAVI, n=41 AVR, n=80 Stroke 4.8 6 Cardiac Tamponade 0 9 GI bleeding 0 4 Permanent pacemaker 24.4 11 30 day mortality 2.4 14 90 day mortality 2.4 19 Inpatient death 2.4 15 Discharge home 90.2 44 Discharge other hospital/ ward 7.3 41 Post-op length of stay (median days) 7 11

Research paper thumbnail of Immediate Outcome of Percutaneous Balloon Mitral Valvotomy in Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal

Nepalese Heart Journal, 2015

background and aim: Percutaneous balloon mitral valvotomy is well established as safe and effecti... more background and aim: Percutaneous balloon mitral valvotomy is well established as safe and effective procedure for patients with mitral stenosis due to Rheumatic Heart Disease. There are some retrospective studies on safety and efficacy of it in different subgroups of patients from our centre. Our study aims to assess the safety, efficacy and outcome of

Research paper thumbnail of Exploration, design and application of simulation based technology in interventional cardiology

Declaration of originality…………………………………………………………………….7 Copyright declaration………………………………………………………... more Declaration of originality…………………………………………………………………….7 Copyright declaration………………………………………………………………………..7 List of peer reviewed publications and presentations……………………………………...8 Successful grant applications………………………………………………………………..9 Public education events in the UK…………………………………………………………..9 Travel Grant-Medtronic, Europe………………………………………………………...10 Courses attended……………………………………………………………………………10 List of figures………………………………………………………………………………..18 List of tables…………………………………………………………………………………21 List of text boxes…………………………………………………………………………….23 Chapter 1: Introduction…………………………………………………………………….24 1.1 Medical Education 1.2 Interventional Cardiology 1.3 Research questions 1.4 Thesis-Aims and objectives 1.5 Structure of the thesis Chapter 2: A literature review on simulation based education in cardiology…………..34 2.1 Chapter overview 2.2 Introduction 2.3 Aims 2.4 Methods 2.5 Results 2.6 Simulation in Interventional Cardiology-Current Status 2.7 Conceptual framework of training in cardiology 2.8 Discussion 2.9 Limitations 2.10 Conclusion Chapter 3: Interviews-Consultants and trainees in cardiology………………………...81 3.1 Chapter overview 3.2 3.8 Conclusion 91 Chapter 4: Questionnaire Survey-Consultants and trainees in cardiology…………..92 4.1 Chapter overview 92 4.2 Introduction 92 4.3 Aims 93 4.4 Methods 93 4.5 Results 97 4.6 Discussion 4.7 Limitations 4.8 Conclusion Chapter 5: Integration of technology in cardiology……………………………………..107 5.1 Chapter overview 5.2 & trainees in cardiology 5.7 Discussion 5.8 Limitations 5.9 Conclusion 5.10 Future Direction Chapter 6: Simulation in cardiology-Pilot study……………………………………...122 6.1 Chapter overview 6.2 6.3 PPCI call study-A prospective, small scale, pilot study 6.3.1 Aims 6.3.2 Methods 6.3.3 Results 6.3.4 Discussion 6.3.5 Conclusion 6.4 Virtual reality cath lab study-Development of clinical scenarios and checklist 6.4.1 Introduction 6.4.2 Aim 6.4.3 Clinical Scenario Development 6.4.4 Assessment Instrument Development 6.5 Overall conclusion Chapter 7: Public education through simulation in cardiology………………………..164 7.1 Chapter overview 7.2 8.2 Thesis findings by aim Aim1: To analyze the background research conducted in the field of simulation training in interventional cardiology Aim 2: To understand the views of senior consultant cardiologists and junior doctors concerning interventional training in cardiology by simulation Aim 3: To explore the potential of simulation as a 'test-bed' for a newly developed computer assisted health care information transfer dashboard (electronic form) to be used by interventional cardiologists in handover situations Aim 4: To develop viable teaching and training scenarios to be conducted in simulated environments Aim 5: To develop clinical case scenarios integrating technology in cardiology to educate the public in cardiovascular diseases through simulation 8.3 Limitations 8.4 Discussion and future direction 8.5 Personal reflections References………………………………………………………………………………….204 Bibliography……………………………………………………………………………….

Research paper thumbnail of OUP accepted manuscript

European Heart Journal

Background Coronary inflammation induces dynamic changes in the balance between water and lipid c... more Background Coronary inflammation induces dynamic changes in the balance between water and lipid content in perivascular adipose tissue (PVAT), as captured by perivascular Fat Attenuation Index (FAI) in standard coronary CT angiography (CCTA). However, inflammation is not the only process involved in atherogenesis and we hypothesized that additional radiomic signatures of adverse fibrotic and microvascular PVAT remodelling, may further improve cardiac risk prediction. Methods and results We present a new artificial intelligence-powered method to predict cardiac risk by analysing the radiomic profile of coronary PVAT, developed and validated in patient cohorts acquired in three different studies. In Study 1, adipose tissue biopsies were obtained from 167 patients undergoing cardiac surgery, and the expression of genes representing inflammation, fibrosis and vascularity was linked with the radiomic features extracted from tissue CT images. Adipose tissue wavelet-transformed mean attenu...

Research paper thumbnail of Public education through simulation in cardiology: Dr Sujatha Kesavan discusses a new method to educate the public on myocardial infarction and its treatment that has been tested in England

European heart journal, 2012

Research paper thumbnail of Women physicians in cardiology and academia

European Heart Journal, 2010

Research paper thumbnail of Use of a defibrillation coil in the coronary sinus to reduce ventricular defibrillation threshold

British Journal of Cardiology, 2007

... Titre du document / Document title. Use of a defibrillation coil in the coronary sinus to red... more ... Titre du document / Document title. Use of a defibrillation coil in the coronary sinus to reduce ventricular defibrillation threshold. Auteur(s) / Author(s). KESAVAN Sujatha ; JAMES Michael A. ; Résumé / Abstract. Although the majority ...

Research paper thumbnail of Risk profile and outcomes of aortic valve replacement in octogenarians

World journal of cardiology, Jan 26, 2011

To investigate the patient characteristics, relationship between the Logistic EuroSCORE (LES) and... more To investigate the patient characteristics, relationship between the Logistic EuroSCORE (LES) and the observed outcomes in octogenarians who underwent surgical aortic valve replacement (AVR). Two hundred and seventy three octogenarians underwent AVR between 1996 and 2008 at Bristol Royal Infirmary. Demographics, acute outcomes, length of hospital stay and mortality were obtained. The LES was calculated to characterize the predicted operative risk. Two groups were defined: LES ≥ 15 (n = 80) and LES < 15 (n = 193). In patients with LES ≥ 15, 30 d mortality was 14% (95% CI: 7%-23%) compared with 4% (95% CI: 2%-8%) in the LES < 15 group (P < 0.007). Despite the increase in number of operations from 1996 to 2008, the average LES did not change. Only 5% of patients had prior bypass surgery. The LES identified a low risk quartile of patients with a very low mortality (4%, n = 8, P < 0.007) at 30 d. The overall surgical results for octogenarians were excellent. The low risk grou...

Research paper thumbnail of Fibroelastomas of the left ventricular outflow tract

Research paper thumbnail of Surgical aortic valve replacement in octogenarians: results in patients who could be considered for transcatheter aortic valve implantation

Heart, Jun 1, 2009

Transcatheter aortic valve implantation (TAVI) is evolving as an alternative to surgical aortic v... more Transcatheter aortic valve implantation (TAVI) is evolving as an alternative to surgical aortic valve replacement (AVR) in octogenarians with symptomatic aortic stenosis who are considered at high risk for surgical mortality and morbidity. Most series of TAVI recipients compare clinical results against surgical risk scores that predict mortality and morbidity. Few data are available for actual surgical results in patients who might now be considered candidates for TAVI. We conducted a retrospective analysis of AVR results in octogenarians in our unit. All data relevant for the current process of selection into the TAVI programme were assessed by review of the patient notes. A subgroup of patients who would formally be considered for TAVI was created and their results were analysed separately. Results 298 patients aged 80 years or older underwent surgical AVR between 1996 and August 2008. Of those, 140 patients had AVR for aortic stenosis and 133 had AVR and bypass surgery for aortic stenosis and symptomatic coronary disease. Out of these groups, 82 (isolated AVR) and 85 (AVR plus coronary artery bypass grafting) had a logistic Euroscore greater than 10. Conclusions The scores used to predict surgical mortality overestimate the risk of the operation in octogenarians. However, registry results of TAVI programmes suggest similar results for high-risk patient cohorts. A direct comparison appears justified.

Research paper thumbnail of P.3. Basic Science, Sudden Death Risk Stratification and Ventricular Arrhythmias

Europace, Oct 1, 2005

The prognostic significance of ventricular arrhythmia and cardiac arrest (from any cause) occurri... more The prognostic significance of ventricular arrhythmia and cardiac arrest (from any cause) occurring during acute myocardial infarction was investigated in 500 consecutive admissions to our CCU. For survivors of these events VT, VF and cardiac arrest were all predictive of increased subsequent mortality, however the predictive value of VF and cardiac arrest is greater than VT. The excess risk is greatest early post infarct. Mortality rates at 1,6 and 12 months in patients with no arrhythmia were 12.2%, 17.7% and 21.6%. In patients who survived VF they were 28.1%(p=0.01), 34.4%(p=0.02) and 37.5%(p=0.04), for cardiac arrest 30%(p= 0.002), 35%(p=0.008) and 42.5%(p=0.003). There was a trend to lower mortality in the events that occurred in the first 24-48 hours but the difference was not significant. For instance the mortality rate at 12 months for early compared with later VF events was 33.3% vs 38.9%, and for cardiac arrest 40% vs 50%. Only VT demonstrated a significant difference between early and late events with VT on admission being less predictive of mortality at 1 year 12.2% vs 32.1%(p=0.04).

Research paper thumbnail of 14. Ventricular Fibrillation & Out-of-Hospital Cardiac Arrest

Europace, Oct 1, 2005

greater involvement of outflow and inflow tracts compared with RV apex and evidenced a lesser inv... more greater involvement of outflow and inflow tracts compared with RV apex and evidenced a lesser involvement of septal wall compared with free wall. In all patients concordance was noted between EA mapping results and non-invasive morphological-functional RV evaluation. Conclusions: voltage mapping appears to be a promising method to study ARVC.

Research paper thumbnail of The Incidence and Outcome of Ventricular Arrhythmia & Cardiac Arrest During MI

Europace, Oct 1, 2005

Introduction: The female gender is known to be more sensitive to drug-induced long QT and cardiac... more Introduction: The female gender is known to be more sensitive to drug-induced long QT and cardiac arrhythmia, based on clinical observations, experimental in vitro data, in isolated rabbit and dog Purkinje fibers, and also in vivo data in rabbits. However, to-date there has been no demonstration of a gender difference in vivo in dogs. As such, the aim of this study was to try and elucidate whether a gender difference is present in this species in vivo. This knowledge is important to drug safety evaluation since conventionally the male dog is the chosen sex for safety pharmacology studies. Methods and Results: We evaluated potential gender differences in the following variables in neuromuscular blocked, mechanically ventilated anesthetized dogs: ventricular repolarization (ECG lead II, QT and qtcv; right ventricular endocardial monophasic action potential (MAP), duration at 90% repolarization, (APD 90), spatial dispersion of the T wave (Tp-Te), instability of qtend (QT TI: total instability), occurrence of eads and/or tdps. These parameters were derived from continuous beat-to-beat recordings of ECG and MAP signals. 20 female and 18 male dogs were treated with dofetilide (0.05 mg/kg i.v. Infusion over 10 min). At baseline, no statistically significant gender difference was observed on the various parameters, whilst dofetilide infusion produced greater electrophysiological alterations in females than in males. The respective median maximum percentage changes from baseline in females versus males were: heart rate (+3% / +6%, ns), QT (+23% / +14%, p = 0.003), qtcv (+20% / +15%, p = 0.03) and APD90 (+26% / +17%, p = 0.006). Dofetilide tended to differently increase Tp-Te (+40% vs +23%, ns) and QT TI (+150% vs +104%), more in female than in male animals. Additionally, dofetilide infusion elicited more incidences of eads on the MAP signal in female than in male dogs (73% versus 48%). Furthermore, the ikr blocker dofetilide (0.05 mg/kg iv) combined with Iks blocker HMR1556 (0.5 mg/kg iv) elicited tdps in 3 out of 4 female dogs in our preliminary investigations. Conclusion: Similar to man, the present study suggests that the female gender may be a risk factor for drug-induced long QT. Indeed, since significant alterations in additional markers beyond QT interval itself appear to be more pronounced in female dogs and eads occur more frequently in this sex, female dogs could be more sensitive to induction of polymorphic ventricular tachycardia (tdp). As such, consideration should be given to incorporation of female dogs into standard cardiovascular safety evaluations, or at least be the chosen single sex for drug safety evaluation, since the use of males may potentially lead to an underestimate of the QT-related pro-arrhythmogenic risk of a new chemical entity.

Research paper thumbnail of Does Timing of VF & Cardiac Arrest During MI Alter its Predictive Value?

Europace, Oct 1, 2005

The prognostic significance of ventricular arrhythmia and cardiac arrest (from any cause) occurri... more The prognostic significance of ventricular arrhythmia and cardiac arrest (from any cause) occurring during acute myocardial infarction was investigated in 500 consecutive admissions to our CCU. For survivors of these events VT, VF and cardiac arrest were all predictive of increased subsequent mortality, however the predictive value of VF and cardiac arrest is greater than VT. The excess risk is greatest early post infarct. Mortality rates at 1,6 and 12 months in patients with no arrhythmia were 12.2%, 17.7% and 21.6%. In patients who survived VF they were 28.1%(p=0.01), 34.4%(p=0.02) and 37.5%(p=0.04), for cardiac arrest 30%(p= 0.002), 35%(p=0.008) and 42.5%(p=0.003). There was a trend to lower mortality in the events that occurred in the first 24-48 hours but the difference was not significant. For instance the mortality rate at 12 months for early compared with later VF events was 33.3% vs 38.9%, and for cardiac arrest 40% vs 50%. Only VT demonstrated a significant difference between early and late events with VT on admission being less predictive of mortality at 1 year 12.2% vs 32.1%(p=0.04).

Research paper thumbnail of 34 Comparison of PCI vs CABG in insulin treated and non-insulin treated diabetic patients in the cardia trial

Research paper thumbnail of Transcatheter aortic valve implantation for patients at high risk of surgical aortic valve replacement: initial experience

Research paper thumbnail of Techniques to aid the implementation of novel clinical information systems: A systematic review

International Journal of Surgery, Nov 1, 2013

Research paper thumbnail of Perivascular Fat Phenotyping Predicts Plaque Progression and Allows Detection of Unstable Plaque Using Coronary Computed Tomography Angiography

Research paper thumbnail of None Reviewer

ventricular outflow tract

Research paper thumbnail of Ventricular Outflow Tract

Research paper thumbnail of 097 Surgical aortic valve replacement in high risk octogenerians vs transcatheter aortic valve implantation

Heart, 2010

Introduction Transcatheter aortic valve implantation (TAVI) is considered to subject less immedia... more Introduction Transcatheter aortic valve implantation (TAVI) is considered to subject less immediate procedural risk than surgical aortic valve replacement (AVR) in high risk elderly patients. Therefore high risk Octogenarians are now being considered for TAVI in preference to AVR. The evidence for this strategy and methods for patient selection are not established. The use of the Logistic Euroscore (LES) in this context has been questioned. We have prospectively compared our TAVI patient characteristics and outcomes with retrospective analysis of high risk Octogenarians who underwent AVR. Methods The records of 273 patients aged 80 and over who underwent AVR at the Bristol Heart Institute between 1996 – 2008 were analysed. Patients with a Logistic Euroscore of 15 and above were identified as high risk including those that had concomitant bypass grafting. All TAVI procedures were performed with the Medtronic Corevalve system between Jan 2008 and Oct 2009. Data was collected prospectively as per the Central Cardiac Audit Database (CCAD) TAVI dataset and all patients were included for comparison. Results Abstract 097 Table 1 80 AVR patients and 41 TAVI procedures were identified. The median LES was 20.7 (average age 83.5, male 51.2%) and 16.4 (average age 83.9, male 48%) respectively. More TAVI patients had previous cardiac surgery (19.5% vs. 15%). The postoperative stroke rate was 4.8% in the TAVI group vs. 6% for AVR. The rate of pacemaker implantation was greater in the TAVI group (24.4% vs. 11%). Abstract 097 Table 1 Patient characteristics TAVI, n=41 AVR, n=80 PCI with TAVI (hybrid)/ CABG + AVR 19.5 54 Previous MI 17 36.25 Diabetic 9.8 4 Renal impairment 39 9 Pulmonary disease 26.8 33 Previous cardiac surgery 19.5 15 Neurological disease (CVA/TIA) 26.3 18 Peripheral vascular disease 26.3 16 EF < 30% 0 19 Logistic Euroscore (median) 16.4 20.7 Mortality rates were significantly lower in the TAVI group (30 day mortality 2.4% vs. 14%, 90 day mortality 2.4% vs. 19%). There was a shorter median postoperative recovery for the TAVI patients prior to discharge (7 days vs. 11 days) and more patients were discharged directly home to indepedence (90.2% vs. 44%). Conclusion In this historical, clinically selected group of Octogenarians the LES appears to correlate well with subsequent surgical risk of AVR. In our current cohort of high risk elderly patients undergoing TAVI there are comparatively lower mortality rates, shorter recovery times and earlier discharges home to independence. However, Corevalve patients are requiring more post-procedure permanent pacemakers. In elderly patients with symptomatic aortic stenosis it is appropriate to use LES as a factor to identify those who are likely to have a better outcome with TAVI compared to traditional AVR. Abstract 097 Table 2 Patient outcomes TAVI, n=41 AVR, n=80 Stroke 4.8 6 Cardiac Tamponade 0 9 GI bleeding 0 4 Permanent pacemaker 24.4 11 30 day mortality 2.4 14 90 day mortality 2.4 19 Inpatient death 2.4 15 Discharge home 90.2 44 Discharge other hospital/ ward 7.3 41 Post-op length of stay (median days) 7 11

Research paper thumbnail of Immediate Outcome of Percutaneous Balloon Mitral Valvotomy in Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal

Nepalese Heart Journal, 2015

background and aim: Percutaneous balloon mitral valvotomy is well established as safe and effecti... more background and aim: Percutaneous balloon mitral valvotomy is well established as safe and effective procedure for patients with mitral stenosis due to Rheumatic Heart Disease. There are some retrospective studies on safety and efficacy of it in different subgroups of patients from our centre. Our study aims to assess the safety, efficacy and outcome of

Research paper thumbnail of Exploration, design and application of simulation based technology in interventional cardiology

Declaration of originality…………………………………………………………………….7 Copyright declaration………………………………………………………... more Declaration of originality…………………………………………………………………….7 Copyright declaration………………………………………………………………………..7 List of peer reviewed publications and presentations……………………………………...8 Successful grant applications………………………………………………………………..9 Public education events in the UK…………………………………………………………..9 Travel Grant-Medtronic, Europe………………………………………………………...10 Courses attended……………………………………………………………………………10 List of figures………………………………………………………………………………..18 List of tables…………………………………………………………………………………21 List of text boxes…………………………………………………………………………….23 Chapter 1: Introduction…………………………………………………………………….24 1.1 Medical Education 1.2 Interventional Cardiology 1.3 Research questions 1.4 Thesis-Aims and objectives 1.5 Structure of the thesis Chapter 2: A literature review on simulation based education in cardiology…………..34 2.1 Chapter overview 2.2 Introduction 2.3 Aims 2.4 Methods 2.5 Results 2.6 Simulation in Interventional Cardiology-Current Status 2.7 Conceptual framework of training in cardiology 2.8 Discussion 2.9 Limitations 2.10 Conclusion Chapter 3: Interviews-Consultants and trainees in cardiology………………………...81 3.1 Chapter overview 3.2 3.8 Conclusion 91 Chapter 4: Questionnaire Survey-Consultants and trainees in cardiology…………..92 4.1 Chapter overview 92 4.2 Introduction 92 4.3 Aims 93 4.4 Methods 93 4.5 Results 97 4.6 Discussion 4.7 Limitations 4.8 Conclusion Chapter 5: Integration of technology in cardiology……………………………………..107 5.1 Chapter overview 5.2 & trainees in cardiology 5.7 Discussion 5.8 Limitations 5.9 Conclusion 5.10 Future Direction Chapter 6: Simulation in cardiology-Pilot study……………………………………...122 6.1 Chapter overview 6.2 6.3 PPCI call study-A prospective, small scale, pilot study 6.3.1 Aims 6.3.2 Methods 6.3.3 Results 6.3.4 Discussion 6.3.5 Conclusion 6.4 Virtual reality cath lab study-Development of clinical scenarios and checklist 6.4.1 Introduction 6.4.2 Aim 6.4.3 Clinical Scenario Development 6.4.4 Assessment Instrument Development 6.5 Overall conclusion Chapter 7: Public education through simulation in cardiology………………………..164 7.1 Chapter overview 7.2 8.2 Thesis findings by aim Aim1: To analyze the background research conducted in the field of simulation training in interventional cardiology Aim 2: To understand the views of senior consultant cardiologists and junior doctors concerning interventional training in cardiology by simulation Aim 3: To explore the potential of simulation as a 'test-bed' for a newly developed computer assisted health care information transfer dashboard (electronic form) to be used by interventional cardiologists in handover situations Aim 4: To develop viable teaching and training scenarios to be conducted in simulated environments Aim 5: To develop clinical case scenarios integrating technology in cardiology to educate the public in cardiovascular diseases through simulation 8.3 Limitations 8.4 Discussion and future direction 8.5 Personal reflections References………………………………………………………………………………….204 Bibliography……………………………………………………………………………….

Research paper thumbnail of OUP accepted manuscript

European Heart Journal

Background Coronary inflammation induces dynamic changes in the balance between water and lipid c... more Background Coronary inflammation induces dynamic changes in the balance between water and lipid content in perivascular adipose tissue (PVAT), as captured by perivascular Fat Attenuation Index (FAI) in standard coronary CT angiography (CCTA). However, inflammation is not the only process involved in atherogenesis and we hypothesized that additional radiomic signatures of adverse fibrotic and microvascular PVAT remodelling, may further improve cardiac risk prediction. Methods and results We present a new artificial intelligence-powered method to predict cardiac risk by analysing the radiomic profile of coronary PVAT, developed and validated in patient cohorts acquired in three different studies. In Study 1, adipose tissue biopsies were obtained from 167 patients undergoing cardiac surgery, and the expression of genes representing inflammation, fibrosis and vascularity was linked with the radiomic features extracted from tissue CT images. Adipose tissue wavelet-transformed mean attenu...

Research paper thumbnail of Public education through simulation in cardiology: Dr Sujatha Kesavan discusses a new method to educate the public on myocardial infarction and its treatment that has been tested in England

European heart journal, 2012

Research paper thumbnail of Women physicians in cardiology and academia

European Heart Journal, 2010

Research paper thumbnail of Use of a defibrillation coil in the coronary sinus to reduce ventricular defibrillation threshold

British Journal of Cardiology, 2007

... Titre du document / Document title. Use of a defibrillation coil in the coronary sinus to red... more ... Titre du document / Document title. Use of a defibrillation coil in the coronary sinus to reduce ventricular defibrillation threshold. Auteur(s) / Author(s). KESAVAN Sujatha ; JAMES Michael A. ; Résumé / Abstract. Although the majority ...

Research paper thumbnail of Risk profile and outcomes of aortic valve replacement in octogenarians

World journal of cardiology, Jan 26, 2011

To investigate the patient characteristics, relationship between the Logistic EuroSCORE (LES) and... more To investigate the patient characteristics, relationship between the Logistic EuroSCORE (LES) and the observed outcomes in octogenarians who underwent surgical aortic valve replacement (AVR). Two hundred and seventy three octogenarians underwent AVR between 1996 and 2008 at Bristol Royal Infirmary. Demographics, acute outcomes, length of hospital stay and mortality were obtained. The LES was calculated to characterize the predicted operative risk. Two groups were defined: LES ≥ 15 (n = 80) and LES < 15 (n = 193). In patients with LES ≥ 15, 30 d mortality was 14% (95% CI: 7%-23%) compared with 4% (95% CI: 2%-8%) in the LES < 15 group (P < 0.007). Despite the increase in number of operations from 1996 to 2008, the average LES did not change. Only 5% of patients had prior bypass surgery. The LES identified a low risk quartile of patients with a very low mortality (4%, n = 8, P < 0.007) at 30 d. The overall surgical results for octogenarians were excellent. The low risk grou...

Research paper thumbnail of Fibroelastomas of the left ventricular outflow tract