Minimally Invasive Atrial Fibrillation Surgery and Left Appendectomy Can Prevent Thrombotic Events
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概要
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<B>Introduction:</B> Atrial fibrillation (AF) is a major cause of fatal stroke, necessitating dangerous doses of coumadin. We tested a hypothesis that endoscopic surgical treatment of AF and left appendage excision can prevent stroke or other thrombotic events. <B>Methods:</B> There were 41 patients (35 men, 6 women, 63±12.5 years old), among which seven (six men, one women, 71±9.5 years old) had the oversized (>6 cm) left atrium. All but two paroxysmal cases had been administered coumadin, but six cases had suffered from thrombotic events. Totally endoscopic ablation plus left appendectomy was accomplished in 34 patients and the seven large-atrial cases underwent stapled appendectomy alone. <B>Results:</B> There was no mortality nor major complications. Intra-operative trans-esophageal echo-cardiography revealed the smoke sign near the appendage completely disappeared after appendectomy. Four ablation cases were unsuccessfully defibrillated, and thus, including the seven appendectomy-only cases, 11 remained AF postoperatively. Thirty-six (88%) cases were cut off from coumadin immediately after surgery, while the remainder was given the greatly reduced dosages. Nevertheless, all cases with the 13.5±9.8 follow-up months are free from thrombotic accidents and one-year post-operative enhanced computed tomography as obtained from 19 patients showed no signs of thrombi in the left atrium. <B>Conclusion:</B> Endoscopic surgical treatment of AF and left appendage excision, even appendectomy alone, can prevent stroke or other thrombotic events, eliminating or mitigating anticoagulant therapy.
著者
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Ninomiya Mikio
Department Of Cardiothoracic Surgery Graduate School Of Medicine University Of Tokyo
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Nonaka Takahiro
Department Of Biology Graduate School Of Science Osaka City University
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Ohtsuka Toshiya
Department of Cardiovascular Surgery, Tokyo Metropolitan Tama Medical Center
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OHTSUKA Toshiya
Department of Cardiothoracic Surgery and the Second Department of Internal Medicine, Faculty of Medicine, University of Tokyo
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Hisagi Motoyuki
Department of Cardiovascular Surgery, Tokyo Metropolitan Tama Medical Center
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Hisagi Motoyuki
Department of Cardiovascular Surgery, Tokyo Metropolitan Fuchu Hospital
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Ninomiya Mikio
Department of Cardiovascular Surgery, Tokyo Metropolitan Tama Medical Center
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