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Dive into the research topics where R. Unnikrishnan Nair is active.

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Featured researches published by R. Unnikrishnan Nair.


The Annals of Thoracic Surgery | 2001

Left ventricular volume reduction without ventriculectomy

R. Unnikrishnan Nair; S.G. Williams; Kingsley U Nwafor; Alistair S. Hall; Lip-Bun Tan

Partial left ventriculectomy (the Batista procedure) to achieve left ventricular volume reduction (LVVR) has been advocated as an alternative to cardiac transplantation in patients with end-stage dilated left ventricles. Here, we describe a new technique of LVVR that uses realignment of the papillary muscles, thus avoiding ventriculectomy, and report preliminary results. Eight patients (all male, mean age 49.3 [range 38 to 70] years) underwent LVVR between October 1998 and March 2000 as an adjunct to surgical coronary revascularization. Five were assessed with echocardiography and cardiopulmonary exercise testing before and after (mean follow-up time 267 [range 94 to 416] days) the operation. LVVR significantly improved left ventricular end-diastolic volume (254 +/- 32 to 218 +/- 36 mL, p = 0.03), left ventricular ejection fraction (20.14% +/- 1.36% to 31.28% +/- 2.32%, p = 0.007), and exercise duration (from 394 +/- 88 to 611 +/- 79 seconds, p = 0.03). A nonsignificant improvement in maximal oxygen consumption was also observed. This technique of LVVR is relatively simple to perform and is accomplished through a small apical cardiotomy. Preliminary results show an encouraging functional improvement following surgery. Future controlled studies are required to assess this novel technique further.


The Annals of Thoracic Surgery | 1993

Bovine internal mammary artery as a conduit for coronary revascularization: Long-term results

Ian M. Mitchell; A. Rashid Essop; Peter J. Scott; Paul G Martin; Nirmal K. Gupta; Nigel R. Saunders; R. Unnikrishnan Nair; Gordon J. Williams

Graft patency after coronary artery bypass grafting depends largely on the choice of conduit. Because an increasing number of patients have insufficient or poor-quality autologous material, there is a need for a suitable synthetic graft that is readily available and easy to handle and that has good long-term patency. Early results suggest that the bovine internal mammary artery graft may meet these criteria. We have used a total of 26 such grafts in 18 patients. Postoperative angiography has been performed in 19 grafts in 14 patients, 3 to 23 months after operation; of these grafts, 3 are currently patent (15.8%, compared with 85.7% and 75.0% patency for native internal mammary artery and saphenous vein grafts in the same patients). We report the results of clotting studies and an analysis of lipid status. These patients do not, however, appear to represent any atypical group, either in terms of coagulopathy, native coronary artery size, or the type of vessel disease. Nevertheless, our poor results contrast markedly with the early enthusiasm reported from other centers.


The Annals of Thoracic Surgery | 1998

Minimally Invasive Reversed Z Sternotomy for Aortic Valve Replacement

R. Unnikrishnan Nair; David A.C Sharpe

The minimally invasive reversed Z sternotomy is a surgical approach for aortic valve operations that provides an excellent view of the aortic root and allows access to the right atrium. It confers the advantages of preservation of the sternocostal articulations and both internal thoracic arteries with no need to enter either pleural cavity. It facilitates aortic and atrial cannulation for cardiopulmonary bypass and allows access for a superior pulmonary vein cardiac vent.


The Annals of Thoracic Surgery | 1998

Limited Lower Sternotomy for Minimally Invasive Mitral Valve Replacement

R. Unnikrishnan Nair; David A.C Sharpe

The minimally invasive limited lower sternotomy is a surgical approach for mitral valve operations with easy access to the left atrium. It confers the advantages of preservation of the sternocostal articulations and both internal thoracic arteries, with no need to enter either pleural cavity or resect the costal cartilages. It facilitates aortic and atrial cannulation for cardiopulmonary bypass, and allows easy access to the mitral valve through the left atrium.


European Journal of Cardio-Thoracic Surgery | 1999

Do not snog the dog : infective endocarditis due to Capnocytophaga canimorsus

Dumbor L. Ngaage; Konstantinos N. Kotidis; Jonathan Sandoe; R. Unnikrishnan Nair

We present a case of prosthetic valve endocarditis and paravalvular abscess caused by the canine bacteria Capnocytophaga canimorsus in a 63-year-old man, who made a habit of snogging his pet dog. Capnocytophaga canimorsus can cause culture-negative endocarditis, therefore a high level of clinical awareness and the appropriate isolation techniques are important for making the diagnosis. Antibiotic therapy and properly timed excision of the infected focus are recommended.


The Annals of Thoracic Surgery | 1997

Prevention of internal thoracic artery spasm

Anvay V. Mulay; Kesava Dev; R. Unnikrishnan Nair

Perioperative spasm of the internal thoracic artery is a common experience in coronary artery bypass grafting. We describe a simple method of harvesting the internal thoracic artery with improved ease of dissection that helps to prevent the arterial spasm.


European Journal of Cardio-Thoracic Surgery | 2003

Intracardiac extension of squamous cell carcinoma of lung.

Kamil Asaad; J. Rafael Sadaba; R. Unnikrishnan Nair

A 61-year-old gentleman presented with palpitations. MRI demonstrated a large left atrial tumour infiltrating left pulmonary veins. These findings were confirmed during surgery. Histology was reported as pulmonary squamous cell carcinoma (Figs. 1 and 2). Fig. 1. Axial (a) and coronal (b) T1-weighted fast spin echo MR images show a mass extending into the left atrium via the left pulmonary vein. Fig. 2. Extended superior left atrial incision showing tumour in left superior pulmonary vein.


Journal of Cardiothoracic Surgery | 2008

Long term survival after coronary endarterectomy in patients undergoing combined coronary and valvular surgery – a fifteen year experience

Sanjay Kumar; Sandeep Agarwala; Charlie Talbot; R. Unnikrishnan Nair

BackgroundCoronary Endarterectomy (CE) in patients undergoing coronary artery bypass graft (CABG) surgery has been shown to be beneficial in those with diffuse coronary artery disease. There are no published data on its role and benefit in patients undergoing more complex operations. We present our experience with CE in patients undergoing valve surgery with concomitant CABG.Materials and methodsBetween 1989 and 2003, 237 patients underwent CABG with valve surgery under a single surgeon at our institution. Of these, 41 patients needed CE. Data was retrospectively obtained from hospital records and database. Further follow-up was obtained by telephone interview. All variables were analyzed by univariate analysis for significant factors relating to hospital mortality. Morbidity and long term survival was also studied. There were 29 males and 12 females with a mean age of 67.4 ± 8.1 and body mass index of 26.3 ± 3.3. Their mean euroscore was 7.6 ± 3.2 and the log euro score was 12.2 ± 16.1.ResultsThirty-two patients were discharged from the intensive therapy unit within 48 hours after surgery. Average hospital stay was 12.7 ± 10.43 days. Thirty day mortality was 9.8%. Six late deaths occurred during the 14 year follow up. Ten year survival was 57.2% (95% CL 37.8%–86.6%). Three of the survivors had Class II symptoms, with one requiring nitrates. None required further percutaneous or surgical intervention. We compared the result with the available mortality figure from the SCTS database.ConclusionCompared to the SCTS database for these patients, we have observed that CE does not increase the mortality in combined procedures. By accomplishing revascularization in areas deemed ungraftable, we have shown an added survival benefit in this group of patients.


Heart Lung and Circulation | 2009

Left anterior descending artery endarterectomy by hydrodissection.

Sanjay Kumar; R. Unnikrishnan Nair

Complete revascularisation of a diffusely diseased left anterior descending (LAD) coronary artery is best done by endarterectomy in conjunction with coronary artery bypass grafting. We describe a simple, effective, and safe technique of performing LAD endarterectomy by hydrodissection.


The Journal of Thoracic and Cardiovascular Surgery | 2002

Familial angiosarcoma of the heart

Aaron R. Casha; Leslie Davidson; P. Roberts; R. Unnikrishnan Nair

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Sanjay Kumar

Leeds General Infirmary

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Ian M. Mitchell

Royal Hospital for Sick Children

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Jonathan Sandoe

Leeds Teaching Hospitals NHS Trust

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