Daisuke Endo

and 9 more

Background: Postoperative atrial fibrillation (POAF) occurs in 20% to 50% of patients soon after cardiac surgery, and is associated with subsequent newly developed AF. Left atrial appendage closure is effective in preventing stroke among patients with nonvalvular AF. However, the prophylactic effect of left atrial appendage amputation (LAAA) in stroke prevention among patients with sinus rhythm has not been proven. Methods: We analyzed 977 consecutive patients undergoing off-pump coronary artery bypass grafting (OPCAB) with sinus rhythm, with or without concomitant LAAA, from 2011 to 2017 at our institution in a retrospective observational manner. A total of 550 patients (56.3%) underwent concomitant LAAA, any effect thereof in preventing early (<30 days) and later stroke was examined. Results: The incidences of POAF and early stroke were not significantly different between the groups. The incidence of later stroke was higher in patients without LAAA than in those with LAAA (4.0% vs. 1.6%; p = 0.02). In a subanalysis of patients without LAAA, stroke occurred more frequently in those with POAF than those without POAF (7.5% vs. 2.7%; p = 0.03), while in patients receiving LAAA, stroke incidences did not differ between those with and without POAF. Multivariate cox proportional hazard model showed POAF without LAAA was the only independent predictor of stroke (HR: 2.86; 95% CI: 1.10 to 7.45; p=0.03). Conclusions: Concomitant surgical LAA amputation during OPCAB reduces the risk of stroke.

Taira Yamamoto

and 6 more

Background and aim of the study: We report our one-year single-center experience of a new technique of aortic valve replacement using a rapid-deployment valve (RD-AVR) to avoid postoperative complications. We also report the unexpected pitfalls and handling techniques that we have seen in past cases. Methods: We performed aortic valve replacement on 38 patients between May 2019 and April 2020. Their mean age was 74 years. The primary outcomes were in-hospital mortality and short-term results during a one-year follow-up period, while the secondary outcomes were related to prosthetic valve function, especially paravalvular leakage (PVL). We further analyzed the relationship between the new technique and its outcomes. Results: The mean operative time was 196 min. There were no in-hospital deaths, and the mean duration of postoperative hospital stay was 11.8 days. Valvular measurements using 3-dimensional computed tomography (3D-CT) were larger and more accurate than those measured using ultrasonic echocardiography Postoperative RD-AVR prosthetic valve function was excellent. However, PVL occurred in 4 cases one week and one year postoperatively and regurgitation did not improve. A gap associated with PVL was identified below the right-noncoronary commissure. To prevent PVL, we additionally stitched this gap in the later 18 cases; there was no case of PVL and no new pacemaker implantation in these cases. Conclusions: PVL is more likely to occur if there is a gap below the R-N commissure, especially in cases with a large annulus; therefore, applying an additional stitch to the R-N commissure is extremely useful.

Jiyoung Lee

and 11 more