Venkatesa Kumar Anakaputhur Rajan1*, Siva kumaran Subbarayan M2, Arun kumar Govindarajan2, Harikrishnan Subramanian M2, Chandrasekar Purushothaman2, Raghuram Arani Raghavendrarao1
1Department of Cardiothoracic Surgery, Kauvery hospital, Alwarpet, Chennai
2Department of Cardiac Anaesthesia, Kauvery hospital, Alwarpet, Chennai
*Correspondence: M: +919566823267, Email: dr.venkatesakumar@gmail.com
Abstract
Background: With increase in the elderly population, octogenerians requiring cardiac surgery have also increased in India. Previous literature suggest that surgical intervention performed in selected patients with preserved physical and mental health can provide acceptable outcomes with good quality of life.
Aim: This study aims to analyze the immediate postoperative outcomes of cardiac surgery in octogenarians.
Result: The Octogenarians (n=21) who underwent cardiac surgery between January 1st, 2017 and July 31st, 2023, were included. The mean age was 81.76 ± 1.76. The incidence of left main coronary artery disease, carotid disease, peripheral vascular disease and history of recent acute coronary syndrome were 13 (65%), 5 (23.8%), 6 (28.6%) and 15 (71.4%), respectively.
Discussion: Mostly, patients underwent elective procedure (n=20, 95.23%) except one patient (4.76%) who underwent emergency Bentall procedure for acute type A dissection. The need for prolonged ventilation, intra-aortic balloon pump usage and pacemaker implantation were 4.76% (n=1), each. Incidence of acute kidney injury was 2 (9.52%), but none of the patients required dialysis. The mean postoperative ICU and hospital stay were 2 and 7 days, respectively. The expected (EuroSCORE II) versus observed in-hospital mortality was 6.25% versus 9.5% (O/E = 1.52).
Conclusion: We conclude that cardiac surgery in Indian octogenerians is safe in selected patients.
Keywords: Octogenarians; Cardiac surgery; Euro score II
Introduction
The life expectancy at birth in Indian population was 69.27 years at 2020[1]. With improvement in life expectancy, elderly population presenting with cardiac diseases has also increased. Several studies performed in other countries have proven that performing cardiac surgery in octogenerians carries higher risk than operating on younger population[2–5]. With necessary risk stratification, and on meticulous case selection, cardiac surgery in octogenerians can provide acceptable outcomes with improved quality of life[2,6–9]. Similarly, a study conducted in Indian scenario has shown that newer surgical techniques have been successful in octogenerians but with increased morbidity and longer hospital stay [10]. This study analyses clinical outcomes in an octogenarian population who underwent cardiac surgery in an Indian setting.
Methods and Materials
This is a retrospective observational study which includes octogenarians (age between 80 to 89 years) who underwent cardiac surgery in our institution between January 1st, 2017 and July 31st, 2023. Those who underwent concomitant non cardiac procedures were excluded from the study. Since this study was retrospective and did not involve contact with patients, ethics committee approval was not obtained.
Outcomes: The primary outcome was the in-hospital mortality. The secondary outcomes include evaluation of postoperative variables like hospital stay, ICU stay, prolonged ventilation, intra-aortic balloon pump usage, permanent pacemaker implantation, re-exploration and incidence of acute kidney injury.
Definition: In-hospital mortality was defined as deaths that occurred during hospital stay following surgery and before discharge. Prolonged ventilation is defined as ventilatory support provided for more than 24 hr after surgery[11]. Acute kidney injury is defined as increase in serum creatinine to 1.5 times or more than baseline of the prior 7 days[12]. Emergency cardiac surgery was defined as the surgery necessarily done within 24 hr of referral to the surgeon[13]. Euro score II was calculated using online calculator
Statistical analysis: Statistical analyses were performed with SPSS software (version 22.0. IBM Corp., Armonk, NY, USA). Continuous variables were described as mean, and variation of each observation from the mean value (Standard deviation) represented as mean ± SD or median and interquartile range (analyzed using Mann Whitney U Test) if they failed to follow a normal distribution. Categorical variables were described by taking percentages.
Key results
During the study period, 1106 patients underwent cardiac surgery, of which 21 patients (1.9%) were included in the study. The baseline, intraoperative and postoperative descriptive variables are given in table 1. The mean age of the population was 81.76 ± 1.76 years, of which majority were male population (90.5%). The incidence of left main coronary artery disease, carotid disease, peripheral vascular disease and history of recent acute coronary syndrome were 13 (65%), 5 (23.8%), 6 (28.6%) and 15 (71.4%), respectively. All the patients underwent elective cardiac surgery, except one patient who underwent emergency Bio – bentall procedure for acute type A aortic dissection. Elective procedures include 17 (81%) off pump coronary artery bypass surgery (CABG), one (4.76%) on pump CABG, one (4.76%) CABG with mitral valve replacement (bioprosthetic valve) and one (4.76%) CABG with aortic valve replacement using a suture-less valve. Prolonged ventilation was required in one patient (4.76%). Incidence of post-operative acute kidney injury was 9.52% (n=2). However, none of them required dialysis. The average ICU and hospital stay was 2 days and 7 days, respectively. None of the patients had neurological stroke or postoperative atrial fibrillation. The mean EuroSCORE II predicted hospital mortality was 6.25% and the observed in-hospital mortality was 9.5% (n=2).
Discussion
Age is a progressive non modifiable risk factor which increases the morbidity and mortality when associated with coronary artery disease[14]. However, the operability of the patients also depends on associated comorbidities, presentation of the disease, patient’s consent and surgeon’s choice. The mean age of our study population was higher than the life expectancy at birth among Indian population[1]. In our study, the incidence of left coronary artery stenosis, peripheral vascular disease, carotid stenosis and diabetes mellitus was high compared to other studies [4,15,16]. This suggests that our subset of population had several confounding factors that affect the overall morbidity and mortality. The analysis on influence of these factors was not feasible due to small sample size. The in-hospital mortality reported among octogenarians ranges from 2- 16.8 % [2–5,8,15] over last two decades. Our in-hospital mortality also falls in the same range (n=2, 9.5%). One patient died of uncontrollable bleeding after emergency bentall operation for acute type A dissection and other patient due to low cardiac output syndrome from acute myocardial infarction post CABG. Mortality in our study was high compared to an in-hospital mortality (n=2, 3.2%) reported in a similar study conducted in Indian population by Khan et al. [10]. Luc et al. [9] concluded that Euro SCORE II had better predictive ability than other commonly used scoring systems among octogenarians after isolated CABG . The comparison of expected mortality as per Euro SCORE II between our study and previous study was 6.25 ± 8.07% versus 4 ± 3% [9], respectively. The increased mean risk associated with our study could be due to the inclusion of valve replacement and emergency bentall procedure to the study population while Luc et al. included only isolated CABG patients. The ratio of observed/ expected mortality in our study is 1.52. This could be due to small sample size, inclusion of emergency case or underestimation of euro score II risk analysis for Indian population because geographic variation with respect to life expectancy is not taken into account.
The incidence of post-operative atrial fibrillation is high in elderly population. Scandrogolia et al. [8] report an incidence of 27% in octogenarians. We report zero incidence of AF postoperatively. We believe that this reduced incidence could be due to routine use of oral amiodarone, atorvastatin prophylaxis in the pre and postoperative period or due to small sample size. Prophylaxis with oral amiodarone is proven to be beneficial in preventing post-operative AF [17] and was prescribed one week prior to the surgery for our patients for the prevention of postoperative atrial fibrillation, to reach a cumulative maximum dose of 3000mg. The dose was adjusted based on baseline heart rate and after ruling out atrio-ventricular heart blocks. Atorvastatin was administered during pre and post-operative period (40/80 mg) as a part of post-operative AF prevention. The use of atorvastatin has been proven beneficial in preventing AF, especially after cardiac surgery[18].
The incidence of stroke is comparatively high in elderly population[3]. Several studies have reported a wide range of stroke incidence from 0.77% [8] to 12% [3]. Our study cohort had zero percent of stroke incidence. The strategies followed to reduce stroke incidence includes, routine pre-operative carotid artery evaluation with doppler, on-table epiaortic ultrasound in all cases and anaortic surgical technique [19] to avoid placing partial clamp on the diseased aorta. The average ICU stay was reported as 4.36 ± 11.41 [4], 4 ± 8 days [8] and 2.6 ± 2.6 days [3] in previous studies, while it was 2 days in our study. Once patients were hemodynamically stable without inotropic supports, after removing chest drains and Foleys catheter, they were mobilized and ambulated before shifting to the ward. The mean hospital stay reported in previous studies ranges from 8 to 10.80 days [3–5,8], it was comparatively low (7 days) in our study. Once the pre-discharge evaluation done by clinical examination, 12 lead electrocardiogram, chest X-ray, 2D echocardiography and blood workup were normal, they were planned for discharge. All the patients were discharged to home and none of them where discharged to a nursing care facility. Previously reported incidences of acute kidney injury were 5.8% [8] and 7.3% [16] , while it was higher in our study with an incidence of 9.52% (n=2). But none of the patients required renal replacement therapy.
Whenever an octogenerian patient was referred to our unit, routine blood workup, 12 lead electrocardiography, and 2D echocardiography were done. Doppler evaluation of bilateral lower limbs and carotids arteries were performed. The operability was confirmed based on initial assessment clinically, preoperative workup, feasibility based on coronary angiogram, frailty and physical activity of the patients. We strongly believe that selection of case plays a major role in outcomes of surgery in octagenerian patients.
Limitations
The major limitations are the retrospective nature of the study, small sample size and the selection bias associated with single surgeon study. Follow-up data in the form of survival percentage, re-hospitalization for cardiac cause, incidence of stroke were not analyzed in the study. Scoring systems that includes frailty of the patient were not used for risk stratification in the study.
Conclusion
Cardiac surgery in octogenarians is safe with acceptable outcomes for selected patients in Indian population.
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Dr. Venkatesa Kumar Anakaputhur Rajan
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Cardio Thoracic Surgery
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- Corona warrior award
- Case Series
- Takotsubo cardiomyopathy
- Learning from Experience – Chapters 3 and 4
- The Consultation Room – Chapters 41 to 45
- Journal scan
- Recommended Reading
- DIAGNOSTIC IMAGE
- Poem from Staff Nurse
- Editorial
- Author Instruction
- Male V. Menstruation and COVID-19 vaccination
- Efficacy and doses of Ulinastatin in treatment of Covid-19 a single centre study
- Electronic registries in health care
- A case report
- Anaemia in pneumonia: A case report
- Successful treatment of two cases of rare Movement Disorders
- Analysis of variance Two-Way ANOVA
- Learning from Experience – Chapters 5 and 6
- The Consultation Room
- Journal Scan
- Recommended Reading
- Diagnostic Image
- Poem from Staff Nurse
- Editorial
- Kauverian eMedical Journal
- An obituary, farewell to a very dear friend
- ‘Vitamin D’: One vitamin, many claims!
- Implantation of Leadless Pacemaker in a middle-aged patient: An ultra-short case study
- ABO-incompatible renal transplant at ease
- Basal cell adenoma parotid: A case report
- A case report
- Learning from Experience – Chapters 7 and 8
- The Consultation Room
- Journal Scan
- Recommended Reading
- Diagnostic Video
- Poem from Staff Nurse
- Editorial
- March – the Month for Minds to dwell on Multiple Myeloma
- Covid Report
- Research Protocol
- New Arrows in our Quiver, to direct against SARS-CoV-2 variants
- Out-of-hospital cardiac arrest
- Last on the list: A diagnosis seldom considered in males
- Giant T wave inversion associated with Stokes: Adams syndrome
- Learning from Experience – Intra Operative, Chapters 9 and 10
- The Consultation Room
- Definitions of probability
- Journal Scan
- Recommended Reading
- Diagnostic Video
- A Thanksgiving to Cardiac Surgeons
- Editorial
- Kauverian eMedical Journal
- Research Article
- Research Protocol
- Saving the unsavable
- Case Report
- Case Report
- Letters to the Editor
- Diagnostic Image
- Learning from Experience – Intra Operative, Chapters 13 and 14
- The Consultation Room
- Journal Scan
- Recommended Readings
- Editorial
- Author Instruction
- SIGARAM – The Club for Children with Diabetes
- The hope for a better tomorrow
- An unusual complication of polytrauma:
- An enigma at the ER
- Dynamic examination of airway
- Journal Club
- Journal Club
- Journal Club
- Conditional Probability
- Diagnostic Image
- Learning from Experience – Intra Operative, Chapters 15 and 16
- The Consultation Room
- Journal Scan
- Recommended Readings
- EDITORIAL
- Kauverian eMedical Journal
- Junior nurses in Kauvery Hospital on the frontline against the COVID-19 pandemic
- Emergency Medicine, the Emerging Specialty: Leading Light on the entrance to the Health Care Pathway
- Battle of two drugs: Who won? – An unusual presentation
- Return of the native and a resurrected foe: A case of Rhinocerebral Mucormycosis
- Covert invader- atypical presentation of neuronal migration disorder
- Fragile heart: an unusual cause of chest pain
- Goldberger’s ECG sign in Left Ventricular Aneurysm
- Congenital absence of bilateral Internal Carotid Artery: A case report
- The Power of Purple
- Beads of Nature’s Rattle
- Case Report
- Diagnostic Image
- EDITORIAL
- Kauverian eMedical Journal
- Modification of Management Strategies, And Innovations, During SARS Cov2 Pandemic Improved the Quality, Criticality and Outcomes in In-Patients “Rising to the occasion”, the mantra for success in the COVID -19 pandemic
- Time in Range (TIR) In Diabetes: A Concept of Control of Glycemia, Whose Time Has Come
- Kauvery Heart Failure Registry- A Concept
- Shorter Course of Remdesivir In Moderate Covid-19 is as Efficacious as Compared to Standard Regime: An Observational Study
- CASE REPORT
- Lymphoepithelial Carcinoma: A Case Report of a Rare Tumour of The Vocal Cord
- Diabetic Keto Acidosis (DKA), Associated with Failed Thrombolysis with Streptokinase in Acute Myocardial Infarction
- EARNING FROM EXPERIENCE – CHAPTERS 1 AND 2
- The Consultation Room
- Journal scan
- Recommended Reading
- DIAGNOSTIC IMAGE
- Notes to Nocturne
- Editorial
- Kauverian eMedical Journal
- Caring for nobody’s baby
- Special Report
- Research Article
- The curious case of a migrating needle on the chest wall
- Foreign body: A boon at times
- Cardiorenal Syndrome
- What My Grandmother Knew About Dying
- Endovascular Therapy for Acute Stroke with a Large Ischemic Region. N Engl J Med. 2022
- Letter to the Editor
- Clinical outcomes of Coronary Artery Disease in Octogenarians
- Diagnostic Image
- Learning from Experience – Intra Operative, Chapters 11 and 12
- The Consultation Room
- Journal Scan
- Recommended Reading
- colours
- Editorial
- Author Instruction
- Ultrashort Case Report
- Cochlear Implantation: Expanding candidacy and Cost Effectiveness
- Spontaneous Pneumomediastinum in COVID 19 – Tertiary Care Centre Experience in South India
- Amoxycillin Induced Anaphylactic Shock: A Case Report
- An Unusual Cause of Seizures: A Case Report
- Case Report
- Educational Strategies to Promote Clinical Diagnostic Reasoning
- Rheumatic Rarities
- Types of sampling methods in statistics
- Diagnostic Image
- Learning from Experience – Intra Operative, Chapters 21 and 22
- The Consultation Room
- Journal Scan
- Recommended Readings
- Editorial
- Author Instruction
- Journal Scan
- Myeloma
- Posterior Reversible Encephalopathy Syndrome (PRES)
- Prophylactic orthopaedic surgery
- Subclavian steal: An interesting imaging scenario
- Spondylo-epi-metaphyseal dysplasia (SEMD)
- The bleeding windpipe
- Learning from Experience – Intra Operative, Chapters 23 and 24
- The Consultation Room
- Diagnostic Image
- Recommended Readings
- Editorial
- Editorial Board
- Physician, Protect thyself
- Foetal Medicine, the Future is here!
- Japanese Encephalitis: A common menace
- Carpometacarpal dislocation with impending compartment syndrome
- Heterotopic pregnancy
- Femoral Trochantric and Proximal Humerus Fracture, from Diagnosis to Rehabilitation
- My Father’s Heart Block
- EPS page
- CRT CSP Cases
- Journal scan
- Learning from Experience – Intra Operative, Chapters 25 and 26
- The Consultation Room
- Recommended Readings
- Editorial
- Editorial Board
- Multiple Sclerosis: An overview
- A flower born to blush unseen
- Guest Editorial
- Radio-frequency ablation as an effective treatment strategy in a case of VT storm post STEMI
- Lymphatic malformation of tongue
- Bilateral anterior shoulder dislocation in epilepsy: A case report and review of literature
- An unusual cause of Stridor
- Monoclonal Antibodies (mAbs) – the magic bullets: A review of therapeutic applications and its future perspectives
- Write the Talk
- Press release and Comments
- Probability Distribution of Bernoulli Trials
- Journal Scan
- Recommended Readings
- poem-v4i4
- Editorial
- Editorial Board
- Research
- Research
- Lambda-cyhalothrin and pyrethrin poisoning: A case report
- Good Enough
- The Monoclonal antibodies (mAbs): the beginning
- Comprehensive trauma course 2022: Trauma Management & Kauvery
- Comprehensive trauma course 2022: Introduction to Comprehensive trauma course
- Diagnostic Image
- Learning from Experience – Intra Operative, Chapters 27 and 28
- The Consultation Room
- Recommended Readings
- Poem
- Editorial
- The Brave New World of Anaesthesia
- Anesthetic considerations in Wilson’s disease for fess: A case report
- The painful story behind modern anaesthesia
- Anesthesia considerations for Ankyslosing Spondylitis
- Total intravenous anaesthesia: An overview
- Risk stratification for cardiac patients coming for non-cardiac surgeries
- The Anaesthesiologist’s role in fluoroscopic guided epidural steroid injections for low back pain
- Awake Craniotomy
- Malpositioned central venous catheter: Step wise approach to avoid, identify and manage
- Benefits outweighing risk: Neuraxial anaesthesia in a patient with Spina Bifida with operated Meningomyelocele
- Pain free CABG: newer horizon of minimally invasive cardiothoracic surgery a walk through anaesthesiologist perspective
- Stellate Ganglion Block: A bridge to cervical sympathectomy in refractory Long QT Syndrome
- Venous Malformation in Upper Airway – Anesthetic Challenges and Management: A Case Report
- Editorial
- USG guided peripheral nerve block in surgery for hernia
- Anaesthesia and morbid obesity: A systematic review
- Patient-Controlled Analgesia
- Parapharyngeal abscess of face and neck: Anesthetic management
- 3D TEE, a boon for the diagnosis of Left Atrial Appendage thrombus!
- Anaesthetic management of difficult airway due to retropharyngeal abscess and cervical spondylosis
- Expect the unexpected – Breach in continuous nerve block catheter
- Lignocaine nasal spray: An easy remedy for Post Dural Puncture Headache
- Potassium permanganate poisoning and airway oedema
- Angioedema following anti-snake venom administration
- Editorial
- Editorial Board
- Ra Fx ablation of Atrioventricular nodal reciprocating tachycardia
- Pace and Ablate Strategy: Conduction system pacing with AV junction ablation for drug refractory atrial arrhythmia – A novel approach
- Why Cardiac Resynchronization Therapy (CRT) For complete heart block? A case discussion
- Pacemakers and Bradyarrhythmias in Diabetic Mellitus
- Outcomes of Total Knee Arthroplasty in patients aged 70 years and above
- An approach to CBC for practitioners
- Acute cerebral sinus venous thrombosis with different presentations and different outcomes: A case series
- Diet and nutritional care for DDLT: A case study
- Vaccine for Dengue (Dengvaxia CYD-TDV)
- Diagnostic Image
- Learning from Experience – Intra Operative, Chapters 31 and 32
- Recommended Readings
- காவிரித்தாய்
- ATLAS OF HAEMATOLOGY AND HEMATOONCOLOGY
- Editorial
- Editorial Board
- Case reports and Case series:
- Usefulness of NEWS 2 score in monitoring patients with cytokine storm of COVID-19 pneumonia
- Treatment approach for extensively Drug-Resistant Tuberculosis (XDR-TB)
- Modified Lichtenstein mesh repair, for a patient of Coronary Artery Disease, Heart Failure and with Implanted Cardioverter- Defibrillator
- Fever-induced Brugada Syndrome
- Pulmonary Thrombo Embolism: When to Thrombolyse?
- Ultra-Short Case Report
- Learning from the failure of Nebacumab
- Journal scan
- Learning From Experience Intra Operative Chapters 29 and 30
- Recommended Readings
- Poem
- Editorial
- Editorial Board
- Heart transplantation: Life beyond the end of life
- Azithromycin to Prevent Sepsis or Death in Women Planning a Vaginal
- Medial retropharyngeal nodal region sparing radiotherapy versus standard radiotherapy
- Proximie: Patient safety in surgery – the urgent need for reform
- Analysis of femoral neck fracture in octogenarians and its management
- Adult Immunisation in Clinical Practice: A Neglected Life Saver
- “Icing” The Eyes
- Doppler vascular mapping in Arterio Venous Fistula (AVF)
- Cosmesis and cure: Radiotherapy in basal cell carcinoma of the dorsum of nose – A case report
- Pulmonary Hypertension and Portal Hypertension
- Comprehensive review of Drug-Induced Cardiotoxicity
- Statistics – Data Collection – Case Study Method
- Atlas of Haematology and Hematooncology
- PRE-OPERATIVE Chapters 1 and 2 – Learning from Experience
- Chapter 2. Uncertainties in medicine in spite of advances
- No Splendid Child
- Editorial
- Editorial Board
- A Young Girl Lost in the Storm
- ECMO as a bridge to Transplant: A case report
- Renal anemia – from bench to bedside
- Mission Possible
- New kids on the block – Update on diabetic nephropathy therapy
- Infections – Trade off in Transplants
- To Give Or Not to Give – Primer on Bicarbonate Therapy
- Sialendoscopy: Shifting paradigms in treatment of salivary gland disease
- Gait imbalance in a senior due to Chronic Immune Sensory Polyneuropathy (CISP)
- Statistics – Mcnemar Test
- Atlas Of Haematology And Hematooncology
- PRE-OPERATIVE Chapters 3 and 4 – Learning from Experience
- Changing trends a challenge to the already trained
- Journal scan
- Recommended Readings
- EDITORIAL
- EDITORIAL BOARD
- PREGNANCY POST-RENAL TRANSPLANT
- BALLOON-OCCLUDED RETROGRADE TRANSVENOUS OBLITERATION
- REVERSE SHOULDER ARTHROPLASTY FOR ROTATOR CUFF ARTHROPATHY
- THE AMBUSH A TEAM APPROACH
- ENDOSCOPIC TRANS-SPHENOID APPROACH FOR PITUITARY ADENOMA EXCISION
- A STUDY ON PRESENTATION AND OUTCOME OF BULL GORE INJURIES IN A GROUP OF TERTIARY CARE HOSPITALS
- A CASE OF INTERNUCLEAR OPHTHALMOPARESIS AS THE FIRST MANIFESTATION OF MULTIPLE SCLEROSIS
- GRANULOMATOSIS WITH POLYANGITIS AND LUNG INVOLVMENT (WEGENER’S DISEASE)
- RITUXIMAB (RITUXAN, MABTHERA) IN THE TREATMENT OF B-CELL NON-HODGKIN’S LYMPHOMA
- STATISTICAL SIGNIFICANCE
- Atlas Of Haematology And Hematooncology
- PRE-OPERATIVE CHAPTERS 5 AND 6 – LEARNING FROM EXPERIENCE
- Chapter 4: Diagnostic process often reversed
- Journal scan: A review of 25 recent papers of immediate clinical significance, harvested from major international journals
- Recommended Readings
- ஆரோக்கியம் நம் கையில்
- வெற்றியின் பாதை
- Editorial
- Editorial Board
- Prevalence of vitamin D deficiency in a multi-speciality hospital orthopaedic outpatient clinic
- Esomeprazole induced Hypoglycemia
- Dynamic external fixator for unstable intra articular fractures of Proximal Interphalangeal Joint (PIP): “Suzuki” frame
- How to Practice Academic Medicine and Publish from Developing Countries? A Practical Guide, Springer Nature, 2022
- WINTNCON 2022 – Scientific Program
- Pulmonary Thrombo Embolism: A state of the art review
- Role of Artificial Intelligence in improving EHR/EMR and Medical Coding and billing
- Monoclonal Antibodies: Edrecolomab and Abciximab
- Atlas of haematology and hematooncology
- Journal scan
- Learning from Experience – Intra Operative, Chapters 31 and 32
- What doctors must learn: Doctor, look beyond science
- Recommended Readings
- I Whisper Secrets In My Ear
- EDITORIAL
- Instructions for Authors
- Mismatched Haploidentical Bone Marrow Transplantation in a 10-year-old boy with relapsed refractory acute lymphoblastic leukemia, at Trichy
- ST-Segment Elevation is not always Myocardial Infarction
- Acyanotic Congenital Heart Disease, repaired, evolves into a Cyanotic Congenital Heart Disease and presents with an atrial tachycardia
- Family medicine – caring for you for the whole of your life. A Lost and Found Art
- The Principles and Practice of Family Medicine
- Complete Heart Block
- Sick Sinus Syndrome (SSS)
- The First Ever National Award Comes to Kauvery Hospital Chennai & Heart City for Safety and Workforce Category in IMC RBNQA Milestone Merits Recognition 2022
- Diagnostic Image
- PRE-OPERATIVE CHAPTERS 7 AND 7 – LEARNING FROM EXPERIENCE
- Chapter 5: Super-specialist – boon or bane
- Journal scan: A review of 42 recent papers of immediate clinical significance, harvested from major international journals
- RECOMMENDED READINGS
- நேரம் ஒதுக்கு
- மருத்துவரின் மகத்துவம்
- EDITORIAL
- Instructions for Authors
- Surgical Management of Covid-19 Associated Rhino-Orbito-Cerebral-Mucormycosis (Ca-Rocm) – A Single Centre Experience
- Knee Joint Preservation Surgeries
- Guest Editorial Comments
- Ventricular Septal (VSR) closure with ASD device
- Newer Calcium Debulking Angioplasty technique of Orbital Atherectomy
- An hour-long CPR to restart the heart
- VT or SVT with aberrancy?
- Pituitary Neuroendocrine Tumor (PitNET)
- VSD Device Closure
- PDA Device Closure
- Iron Deficiency Anemia, Post MVR
- Torsades de Pointes
- Quality improvement project to Reducing the Malnutrition Rate of ICU patients from 43% to 20%
- Long term use of Amiodarone in Cardiac patients: A Clinical Audit
- Statistical Independent Events and Probability
- PERI-OPERATIVE Chapters 9 and 10 – Learning from Experience
- Journal scan: A review of 40 recent papers of immediate clinical significance, harvested from major international journals
- EDITORIAL
- Kauverian Medical Journal
- First da Vinci Robotic Surgery in Carcinoma Prostate: A Case Report
- Black burden or Taylor the saviour: A case report
- Analysis of differences in Oncology practice between the United Kingdom and India
- A Case of Takayasu Arteritis
- Idiopathic Dilated Pulmonary Artery (IDPA)
- ECG Atlas
- Unusual cause of Dysphagia: A case report
- Tu Youyou: The scientist who discovered artemisinin
- Continuing Nursing Education (CNE) on Risk assessment tools, to assess vulnerable patients at Kauvery Hospital, Tennur
- DIAGNOSTIC IMAGE
- PRE-OPERATIVE CHAPTERS 11 AND 12 – LEARNING FROM EXPERIENCE
- OLD AND NEW – MAKE THE BEST OF THE TWO
- Journal scan: A review of 30 recent papers of immediate clinical significance, harvested from major international journals
- Recommended Readings
- EDITORIAL
- INSTRUCTION TO AUTHORS
- A pregnant patient with DKA, septic shock and a lactate mystery
- Radical Thymectomy in Myasthenia Gravis through Partial Sternotomy approach: A report on three patients
- In-utero blood transfusion in two etiologically distinct anaemic fetus
- RARE CAUSE OF PULMONARY HYPERTENSION
- Acute Rheumatic fever is still an enigma
- A remarkable journey: Managing LQTS in a 43-year-old female with recurrent syncope and seizure
- An unusual case of Acute Coronary Syndrome
- Reversible cause of severe LV Dysfunction in Left Bundle Branch Block
- A case study on Rhino-Orbital-Cerebro- Mucormycosis
- Snakebite and its management
- Total Elbow arthroplasty in Post Traumatic arthritis
- Wellens Syndrome: An ECG finding not to miss!
- Dr. C.R. Rao Wins Top Statistics Award a look back at his pioneering work
- PRE-OPERATIVE Chapters 13 and 14 – Learning from Experience
- Chapter 7. Doctor-patient relationship
- Journal scan: A review of 30 recent papers of immediate clinical significance, harvested from major international journals
- EDITORIAL
- INSTRUCTION TO AUTHORS
- FROZEN ELEPHANT TRUNK (FET) PROCEDURE IN A 52 YEARS OLD CHRONIC AORTIC DISSECTION PATIENT
- DIAGNOSING AND MANAGING EISENMENGER SYNDROME IN A YOUNG MALE
- STEMI EQUIVALENT BUT STEMI!
- TEMPORARY HEAL CAN POSSIBLY KILL!
- UNDERSTANDING PUBERTY
- THE IMPORTANCE OF STATISTICS IN HEALTHCARE
- JOURNAL SCAN: A REVIEW OF 44 RECENT PAPERS OF IMMEDIATE CLINICAL SIGNIFICANCE, HARVESTED FROM MAJOR INTERNATIONAL JOURNALS
- DIAGNOSTIC IMAGE
- PRE-OPERATIVE CHAPTERS 15 AND 16 – LEARNING FROM EXPERIENCE
- CHAPTER 8. DOCTOR-DOCTOR RELATIONSHIP
- EDITORIAL
- GUEST EDITORIAL
- CLINICAL AUDIT: AN INTRODUCTION
- YOUNG ACS AUDIT
- CLINICAL AUDIT: ANAESTHESIA
- CLINICAL OUTCOME IN ICU PATIENTS
- RATE OF MALIGNANCY IN INDETERMINATE OVARIAN CYST – A PROCESS AUDIT
- PATTERNS OF NEEDLE DISPOSAL AMONG INSULIN USING PATIENTS WITH DIABETES MELLITUS: AN AUDIT
- CONTINUOUS PATIENT MONITORING – LIFE SIGNS
- AGE IS JUST A NUMBER!
- SVT WITH LEFT BUNDLE BRANCH BLOCK FOLLOWING GASTRECTOMY
- COMPLEX AORTIC DISSECTION WITH MULTIFACETED CLINICAL PRESENTATIONS
- EDITORIAL
- POST-OPERATIVE SORE THROAT IN GA: A CONCERN
- NEONATAL HLH: OUR EXPERIENCE
- CLINICAL REVIEW MEET 16TH NOV 2023: CHALLENGES IN SETTING UP A NEW HSCT CENTRE IN A TIER-2 CITY IN INDIA
- CARDIAC BIOMARKERS: CLINICAL UTILITY
- HIRAYAMA DISEASE: A CLINICAL-RADIOLOGICAL REVIEW
- ECG AS A WINDOW OF OPPORTUNITY: FOR HYPERKALEMIA
- EFFECTIVENESS OF ROOD’S APPROACH BASED PAEDIATRIC OCCUPATIONAL THERAPY MANAGEMENT: ON CHILDREN WITH CONGENITAL MUSCULAR TORTICOLLIS
- ELTROMBOPAG, A NOVEL THROMBOPOIETIN (TPO) RECEPTOR AGONIST: AN OVERVIEW
- HENOCH-SCHONLEIN PURPURA
- SUBMANDIBULAR GLAND SIALADENITIS SECONDARY TO SUBMANDIBULAR CALCULUS
- LEAN HOSPITALS
- STATISTICS BLACK-SCHOLES MODEL
- PERI-OPERATIVE CHAPTERS 17 AND 18 – LEARNING FROM EXPERIENCE
- CHAPTER 9. BUILDING BLOCKS OF PATIENT CARE
- JOURNAL SCAN: A REVIEW OF 30 RECENT PAPERS OF IMMEDIATE CLINICAL SIGNIFICANCE, HARVESTED FROM MAJOR INTERNATIONAL JOURNALS
- EDITORIAL
- INSTRUCTIONS TO AUTHORS
- ROTATHON-SERIES OF SUCCESSFUL ROTA CASES LAST 2 MONTHS: AN AUDIT
- OUTCOMES OF AKI AUDIT IN KAUVERY
- ETIOLOGY, CLINICAL CHARACTERISTICS AND OUTCOMES OF PATIENTS WITH ACUTE PANCREATITIS IN KAUVERY CANTONMENT HOSPITAL (KCN), TRICHY
- USE OF BLOOD PRODUCTS AND STEROIDS IN THE MANAGEMENT OF DENGUE AT KAUVERY TRICHY HOSPITALS: A CLINICAL AUDIT
- A CLINICAL AUDIT: ON THE MANAGEMENT OF ECTOPIC PREGNANCY
- DIABETIC KETOACIDOSIS WITH HIGH ANION GAP METABOLIC ACIDOSIS
- HYPOKALEMIC PARALYSIS FROM DISTAL RENAL TUBULAR ACIDOSIS (TYPE-1)
- DELAYED PRESENTATION OF INTERMEDIATE SYNDROME IN A PATIENT WITH ORGANOPHOSPHORUS POISONING: A CASE REPORT
- SCAPULA FRACTURES: DO WE NEED TO FIX THEM?
- SPONTANEOUS CSF RHINORRHEA
- DANCING WITH DIABETES: AN UNUSUAL CASE OF CHOREA HYPERGLYCEMIA BASAL GANGLIA SYNDROME
- CONVALESCENT RASH OF DENGUE
- ECG ATLAS 2
- MI MIMICKER
- PERFORATION PERITONITIS-A CASE REPORT
- APPLICATION OF EVIDENCE BASED PRACTICE CARE FOR INDIVIDUALS WITH SPINAL CORD INJURY WITH FUNCTIONAL DIFFICULTIES: ROLE OF THE OCCUPATIONAL THERAPY PRACTICE GUIDELINES
- METHOTREXATE INDUCED MUCOSITIS AND PANCYTOPENIA: A CONSEQUENCE OF MEDICATION ERROR IN A PSORIASIS PATIENT
- POST OPERATIVE CHAPTERS 1 AND 2 – LEARNING FROM EXPERIENCE
- CHAPTER 10. NURTURING SELF
- விடாமுயற்சி வெற்றி தரும்
- JOURNAL SCAN: A REVIEW OF 26 RECENT PAPERS OF IMMEDIATE CLINICAL SIGNIFICANCE, HARVESTED FROM MAJOR INTERNATIONAL JOURNALS
- EDITORIAL
- EDITORIAL BOARD
- LIMB SALVAGE IN EXTREMITY VASCULAR TRAUMA: OUR EXPERIENCE
- MANAGEMENT OF URETHRAL CATHETER RELATED PAIN IN RENAL TRANSPLANT RECIPIENTS: A CLINICAL AUDIT
- NO PAIN VEIN GAIN WITH PRILOX IN PAEDIATRIC POPULATION
- GUIDELINE-DIRECTED MEDICAL TREATMENT (GDMT) OF HEART FAILURE AT KAUVERY HOSPITALS: A CLINICAL AUDIT
- PATIENTS STORY: DIGNITY MATTERS
- PATIENTS STORY: DIGNITY MATTERS
- VIDEO PRESENTATION- CT CORONARY ANGIOGRAPHY
- DRUG INDUCED HYPERKALEMIA
- ADULT NEPHROTIC SYNDROME
- EXPLORING COMPLEX CARDIAC CASES: INSIGHTS FROM DIVERSE PRESENTATIONS IN MID-AGED WOMEN
- EFFECTIVENESS OF ACTIVITY CONFIGURATION APPROACH BASED OCCUPATIONAL THERAPY INTERVENTION FOR CHILDREN WITH CONGENITAL MUSCULAR TORTICOLLIS: A CASE STUDY
- CARDIOMYOPATHY AND ITS ECHO FINDINGS
- THE STRESS TEST ON THE TREADMILL
- POST OPERATIVE CHAPTERS 3 AND 4 – LEARNING FROM EXPERIENCE
- CHAPTER 11. BALANCE IN LIFE BEYOND BANK BALANCES
- JOURNAL SCAN: A REVIEW OF 30 RECENT PAPERS OF IMMEDIATE CLINICAL SIGNIFICANCE, HARVESTED FROM MAJOR INTERNATIONAL JOURNALS
- காணும் பொங்கலும் மனித மன மாற்றமும்
- EDITORIAL
- INSTRUCTIONS TO AUTHORS
- PREVALENCE OF STREPTOCOCCUS PNEUMONIAE SEROTYPES IN AND AROUND TRICHY AND ITS CLINICAL RELEVANCE
- ANAESTHETIC MANAGEMENT OF A PATIENT WITH HUGE GOITER: A CASE REPORT
- EUGLYCEMIC DIABETIC KETOACIDOSIS A RARE CAUSE FOR DELAYED EXTUBATION
- SUCCESSFUL PREGNANCY IN ASD PATIENT – COMPLICATED BY SEVERE PULMONARY ARTERIAL HYPERTENSION
- ENDOCRINE COMPLICATION OF GROWTH HORMONE SECRETING TUMOR: A CASE REPORT
- EFFICACY OF EARLY DIAGNOSIS AND DEVELOPMENT APPROACHES OF PAEDIATRIC OCCUPATIONAL THERAPY ON ACUTE DISSEMINATED ENCEPHALOMYELITIS: A CASE REPORT
- POST OPERATIVE CHAPTERS 5 AND 6 – LEARNING FROM EXPERIENCE
- CHAPTER 12. MILES TO GO – BEFORE TEACHING BECOMES LEARNING
- JOURNAL SCAN: A REVIEW OF 26 RECENT PAPERS OF IMMEDIATE CLINICAL SIGNIFICANCE, HARVESTED FROM MAJOR INTERNATIONAL JOURNALS
- காவேரி – 25
- POEM – மண்ணில் பிறந்தது சாதிப்பதற்குத்தான்
- EDITORIAL
- EDITORIAL BOARD
- Audit Appraisal: An overview
- Intra Ventricular antibiotics: Our experience
- Transfusion Reactions: A clinical audit
- Postoperative pain management
- Rising concerns of Carbapenem resistant Enterobacteriaceae and the options available: An overview
- Ultrashort case report on VF storm in immediate Post CABG Period—‘Angry Purkinje Syndrome’
- Lynch syndrome, diagnostic challenges and management: A case report
- Bilateral posterior shoulder fracture – dislocation due to seizure, an uncommon injury: A case report
- Navigating amlodipine overdose: A multi-disciplinary approach in a 23 year old female
- Exploring the interplay between sleep patterns and behavioural characteristics in individuals with Autism Spectrum Disorder (ASD)
- POST OPERATIVE Chapters 7 and 8 – Learning from Experience
- Chapter 13. Art of communication and counselling
- Journal scan: A review of 20 recent papers of immediate clinical significance, harvested from major international journals
- மருத்துவமனையின் தேவதையே
- மருத்துவ சிந்தனை விருந்து
- Editorial
- Instructions for Authors
- Cardiac surgery in an octogenarian Indian population
- Mycotic Aortoiliac Aneurysm: A case series
- The Scorpion Block—A Sting operation
- Arterial Thoracic Outlet Syndrome: A case report
- Infective endocarditis in adult congenital heart disease: A case report
- Takotsubo cardiomyopathy: A case report
- Cerebral Venous Thrombosis (CVT): A case report
- Hemophagocytic Lymphohistiocytosis in Dengue
- A prospective observational study on the prescription of Guideline Directed Medical Treatment (GDMT) for Heart Failure at Kauvery Heart City
- Guideline-Directed Medical Treatment (GDMT) of Heart Failure at Kauvery Hospitals: A clinical audit
- POST OPERATIVE Chapters 9 and 10 – Learning from Experience
- Chapter 14. How to keep updated in busy medical practice?
- Journal scan: A review of 15 recent papers of immediate clinical significance, harvested from major international journals
- சிந்தனையே சிறப்பு
- தோல்வியே வெற்றியின் பாதை
- Editorial
- Results of Mechanical Thrombectomy in acute stroke: A case study in a Tier 2 city in India
- A clinical audit—cost effective way of managing superficial chest wound infections post sternotomy
- Dental implants: Our experience and expertise
- A non-randomized retrospective study on the management of pediatric septic arthritis
- Analysis of femoral neck fracture in octogenarians and its management
- Airway management of a huge thyroid: A case report
- Cardiac Arrhythmias in the ER setting
- Effectiveness of tactile-spatial oriented approach based paediatric occupational therapy intervention for children with Infantile Hemiplegia
- Corporate citizenship in healthcare: Nurturing social responsibility
- Guillain-Barré syndrome: A case report
- POST OPERATIVE Chapters 11 and 12 – Learning from Experience
- Chapter 15. How to be rational in practice?
- Journal scan: Elsevier’s Medicine, Current Issue, Volume 52 Issue 6, June 2024, Seminar on Poisoning
- Recommended Readings
- இயற்கை சொல்லும் செய்தி
- Editorial
- Instructions for Authors
- A rare organism causing septic arthritis of hip joint
- ICD implant in 6 year old with Jervell and Lange-Nielsen (JLN) syndrome
- A clinical audit on Bariatric/Metabolic surgery
- Clinical audit on Nil per Oral (NPO)
- A non-randomized clinical study on heat stroke
- Stress cardiomyopathy with posterior reversible encephalopathy syndrome in Eclampsia
- Intro-Reversible Cerebral Vasoconstriction Syndrome (RCVS): An ultra-short case report
- A 2 am Tamponade: Critical call to action
- Immune Checkpoint Inhibitors, and in combination with JAK inhibitors: The modelling for the future
- Optimizing the patient journey in hypertrophic cardiomyopathy—Patient and clinician perspectives: Summary of CME from Medscape
- ER Intervention
- Diagnostic Images/Videos
- A randomized controlled trial: Different types of blinding
- Journal scan – June
- Journal scan – July
- Post-Operative Chapters 13, 14
- Chapter 16. How to enjoy medical practice?
- Driving business growth with 5S and lean strategies: A transformative session for corporations in the Trichy region
- Poem: 25 – வருடங்களாக காவேரி
- Editorial
- A Data Audit: Tool for Good Clinical Practice
- Ortho rehab audit at Kauvery Hospital, Trichy
- Endovascular Thrombectomy in young patient with a stroke – surgical procedure decompressive craniotomy
- Secondary HLH (Hemophagocytic Lymphohistiocytosis): An ultra-short case report
- Prone ventilation: A case series
- Dermatologic Emergencies: A case series
- Managing DKA at the ER
- Podcast – Managing DKA at the ER
- Insertion of tunneled hemodialysis catheter through the collateral vein adjacent to the thrombosed right jugular vein.
- Access failure with dysfunctional tunnelled haemodialysis catheter in the presence of exit-site infection
- Video – A multidisciplinary approach to preventing sudden cardiac death
- Dasatinib in pediatric Chronic Myeloid Leukemia: An overview
- Dyslipidemia management: Indian perspective
- Pharmacological stress testing: Assessing heart health without exercise
- Journal scan: A review of 15 Ethics with clinical significance, harvested from a major international journal
- Post-Operative Chapters 15 and 16
- Chapter 17. How to find time for the family
- Poem – உனக்காக நீ
- Editorial
- An audit: A silent disease-Osteoporosis
- An approach to antibiotic therapy: A primer for all specialties
- Audit on pediatric Cholesteatoma
- Clinical audit: ER to ICU transit time
- A case report on Multiple myeloma: Value of pre and post-treatment MRI
- Unrelated donor bone marrow transplantation in 3 year old with Acute Myeloid Leukemia
- Infective endocarditis: A case series
- A Retrospective observational study on Scrub typhus paediatric population in Kauvery Hospitals, Trichy
- Clinical Pharmacy Approach: To a patient on multiple anticonvulsants for “Difficult to control’’ seizure disorder
- An analysis of the Urea to Creatinine Ratio (UCR) in different cardiac surgeries
- Journal scan – 1
- Journal Scan – 2
- Post-Operative Chapters 17 and 18
- Chapter 18. How to be legally safe in medical practice?
- Poem – காவேரியின் மாரத்தான்
- Poem – ஆரோக்கியம் என்னுடையது
- Extraordinary Edition of the Kauverian