Stroke is a major adverse event in patients developing atrial fibrillation (AF) after cardiac surgery. Surgical left atrial appendage amputation/ligation (LAA-A/L) during off-pump coronary artery bypass grafting (OPCAB) is routinely performed in our institution. We analyzed 578 consecutive patients (mean age 69 years, male 82%) undergoing OPCAB with or without concomitant LAA-A/L from 2011 to 2014 at our institution in a prospective observational manner. The safety and efficacy of the concomitant LAA-A/L on preventing early (<30 days) and overall postoperative stroke were examined. A total of 193 patients (33.4%) underwent LAA-A/L, consisting of amputation in 154 and ligation in 39 patients (80 and 20% of the cases, respectively). Preoperative characteristics, operative time, requirement of blood transfusion, and 30-day mortality were not significantly different between those with and without LAA-A/L. The incidences of postoperative AF and early and overall stroke were not significantly different between the groups in the analysis based on a total cohort. In a subanalysis of patients without LAA-A/L, early and overall stroke occurred more frequently in those developing postoperative AF than those without AF (2.8 vs. 0%; p = 0.005, 6.2 vs. 1.5%; p = 0.017, respectively), while in patients receiving LAA-A/L, stroke incidences did not differ between those with and without AF. Multivariate logistic regression showed postoperative AF without LAA-A/L as the only independent positive predictor of overall stroke (OR 3.69, p = 0.03). Concomitant LAA-A/L with OPCAB can safely prevent postoperative stroke occurrence in case patients develop AF, the most common arrhythmia associated with stroke.
Background: The Maze procedure in patients without mitral valve disease remains controversial, because of the increased invasiveness and operation time required to create additional incisions in the atria. The ain of this study was to assess prognosis following the Maze procedure in patients without mitral valve disease. Methods and Results: One hundred and seven consecutive patients who underwent the Maze procedure between 2002 and 2008 was enrolled in this study. Patients were divided into two groups based on the presence or absence of mitral valve disease. Freedom from atrial fibrillation was compared by multivariate logistic regression analysis at discharge. The KaplanMeier method and Cox-proportional hazard analysis adjusted for other predictors were estimated to compare freedom from atrial fibrillation at follow-up. Follow-up was 98% complete and mean duration of follow-up was 457 days. Operation and aorta cross-clamp times were similar between groups. No differences were identified in freedom from atrial fibrillation at discharge (non-mitral valve surgery, 55% vs. mitral valve surgery, 66%) or follow-up (57% vs. 61%, respectively). In multivariate Cox proportional hazard modelling, the presence of mitral valve disease was not associated with a poor success rate of conversion. Conclusions: Results of the Maze procedure for atrial fibrillation without mitral valve disease were acceptable. The Maze procedure could be a beneficial option for these patients to avoid adverse events of atrial fibrillation.
Renal cell carcinoma is known to metastasize via blood flow, but metastasis of renal cell carcinoma to the nasal cavity and paranasal sinuses is rare. Here, we report a case of a 74-year-old male patient who presented with epistaxis for 2 months and buccal paresthesia for 5 months before his first visit to our clinic.He had a past medical history of right nephrectomy due to renal cell carcinoma and of multiple resections for 日 鼻 誌 62 (1) :153~158, 2023
Objective:Analyses based on the results of various clinical studies have shown a gender difference in the significance of lifestyle and risk factors that cause progression of atherosclerosis. However, there have been few investigations of gender differences in secondary prevention of the most severe form of atherosclerosis, which follows coronary revascularization in diabetes patients with multivessel coronary artery disease. Methods:the subjects were 493 diabetic patients(394 males and 99 females) with multivessel disease who underwent coronary artery revascularization at our hospital between 2002 and 2008. Death from all causes, cardiac death, and major adverse cardiac and cerebrovascular events(MACCE) were compared between men and women. Kaplan-Meier survival analysis was performed with univariate analysis of each endpoint. The multivariate Cox proportional hazard model was then used to calculate the hazard ratio.Results:The mean age of the women was 70 years, significantly higher than the 64 years for men. During a mean follow-up period of 2. 6 years, no gender differences were seen in all-cause deaths, cardiac deaths, or MACCE on multivariate analysis.Conclusions:This study demonstrated that there were no gender differences related to long-term outcome at any of the end points in secondary prevention of severe coronary artery disease in diabetes patients.
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