Dr. Praveen Varma currently serves as Clinical Professor & Head at the Department of Cardiovascular and Thoracic Surgery (C.V.T.S.), School of Medicine, Kochi.

QUALIFICATION : MS (General Surgery), MCh (CVTS)


Publication Type: Journal Article

Year of Publication Title


A. Gurram, Krishna, N., Anu Vasudevan, Baquero, L. Alberto, Jayant, A., and Dr. Praveen Varma, “Female Gender is not a Risk Factor for Early Mortality after Coronary Artery Bypass Grafting.”, Ann Card Anaesth, vol. 22, no. 2, pp. 187-193, 2019.[Abstract]

<p><b>Background: </b>The female gender is considered as a risk factor for morbidity and mortality after coronary artery bypass grafting (CABG).</p>

<p><b>Aim: </b>In this analysis, we assessed the impact of female gender on early outcome after CABG.</p>

<p><b>Study Design: </b>This is a retrospective analysis of data from our center situated in South India.</p>

<p><b>Statistical Analysis: </b>Patients were categorized according to gender and potential differences in pre-operative and post-operative factors were explored. Significant risk factors were then built in a multivariate model to account for differences in predicting gender influence on surgical outcome.</p>

<p><b>Methods: </b>773 consecutive patients underwent first time CABG between January 2015 and December 2016. 96.77% of cases were performed using off-pump technique. 132 (17.07%) patients were females. These patients formed the study group.</p>

<p><b>Results: </b>The in-house/ 30-day mortality in females was similar to that of males (3.03% vs. 3.12%, p value 0.957). Mediastinitis developed more commonly in females (5.35% vs. 1.30%; p value 0.004) compared to males. There were more re-admissions to hospital for female patients (21.37% in females vs. 10.14% in males, p value &lt;0.001). In multivariate analysis using logistic regression; there was a significant association between age (OR 1.08), chronic obstructive airway disease (OR 4.315), and use of therapeutic antibiotics (OR 6.299), IABP usage (OR 11.18) and renal failure requiring dialysis (OR 28.939) with mortality.</p>

<p><b>Conclusions: </b>Early mortality in females was similar to that of males. Females were associated with higher rate of wound infection and readmission to hospital.</p>

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Rajesh Jose, Shetty, A., Krishna, N., Chathoth, V., Renjitha Bhaskaran, Jayant, A., and Dr. Praveen Varma, “Early and Mid-Term Outcomes of Patients Undergoing Coronary Artery Bypass Grafting in Ischemic Cardiomyopathy.”, J Am Heart Assoc, vol. 8, no. 10, p. e010225, 2019.[Abstract]

Background Many observational studies and trials have shown that coronary artery bypass grafting improves the survival in patients with ischemic cardiomyopathy. However, these results are based on data generated from developed countries. Poor socioeconomic statuses, lack of uniformity in healthcare delivery, differences in risk profile, and affordability to access optimal health care are some factors that make the conclusions from these studies irrelevant to patients from India. Methods and Results One-hundred and sixty-two patients with severe left ventricular dysfunction (ejection fraction ≤35%) who underwent coronary artery bypass grafting from 2009 to 2017 were enrolled for this study. Mean age of the study population was 58.67±9.70&nbsp;years. Operative mortality was 11.62%. Thirty day/in-house composite outcome of stroke and perioperative myocardial infarction were 5.8%. The percentage of survival for 1&nbsp;year was 86.6%, and 5-year survival was 79.9%. Five-year event-free survival was 49.3%. The mean ejection fraction improved from 30.7±4.08% (range 18-35) to 39.9±8.3% (range 24-60). Lack of improvement of left ventricular function was a strong predictor of late mortality (hazard ratio, 21.41; CI 4.33-105.95). Even though there was a trend towards better early outcome in off-pump CABG , the 5-year survival rates were similar in off-pump and on-pump group (73.4% and 78.9%, respectively; P value 0.356). Conclusions We showed that coronary artery bypass grafting in ischemic cardiomyopathy was associated with high early composite outcomes. However, the 5-year survival rates were good. Lack of improvement of left ventricular function was a strong predictor of late mortality.

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Dr. Praveen Varma, Raman, S. P., Neema, P. K., and Shekar, P. S., “Hypertrophic cardiomyopathy”, Indian Journal of Thoracic and Cardiovascular Surgery, vol. 31, pp. 153-161, 2015.[Abstract]

Hypertrophic cardiomyopathy is a common genetic cardiovascular disease affecting the general population with an estimated prevalence of 1 in 500 with autosomal dominant pattern of inheritance and is an important cause of intractable heart failure. Up to 70 % of patients present with left ventricular outflow tract obstruction due to asymmetric hypertrophy of the interventricular septum and systolic anterior motion of anterior mitral leaflet. These patients are initially managed with medical treatment. Persistent symptoms (dyspnea and chest pain NYHA class 3 or 4 and syncope) in spite of optimal medical therapy and presence of gradients above 50 mm of Hg at rest or by provocation are usually referred for invasive strategy. Extended surgical myectomy and alcohol septal ablation are current strategies employed for relief of left ventricular outflow tract gradients. There is a higher incidence of residual gradients, more incidences of conduction blocks requiring pacemaker implantation and more risk of life-threatening arrhythmias with alcohol ablation compared to surgery and hence is currently recommended as a treatment option only in elderly patients with poor risk profile for surgery. Early and long-term results after surgery are excellent, making it as the gold standard for management of hypertrophic cardiomyopathy. © 2015, Indian Association of Cardiovascular-Thoracic Surgeons.

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Dr. Praveen Varma, “Risk Assessment Scores in Cardiac Surgery”, Annals of Cardiac Anaesthesia, vol. 18, pp. 170-171, 2015.