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108First performed in 1949, surgical LAA excision is one of the oldest surgical procedures. Since then, many methods have been improved and accom-plished, but along with good results, problems have become apparent. Recently, the Society of Thoracic Surgeons 2017 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation recom-mended Class IIa for LAA closure34). Specifically, in patients with contraindications to anticoagulation and at a high risk of stroke, left ventricular processing has been determined to be optimal and necessary. A recent study reported that 4,374 (5.8%) of 75,782 patients undergoing cardiac surgery underwent simultaneous left auricular occlusion (LAAO), with a mean follow-up of 2.1 years. They reported that LAAO reduced cerebral infarction and simultaneous LAAO in open-heart surgery reduced all-cause mortality and stroke. However, approximately 75% of the patients had AF. However, this study did not prove the efficacy of LAAO in patients without a history of preoperative AF35).Advances in preoperative imaging have been remarkable, and preoperative imaging, such as electrocardiogram gated three-dimensional computed tomography and transesophageal echocardiog-raphy, is of utmost importance in defining the anatomy of the LAA and is essential for protocol development, including the selection of appropriate devices. Anatomical considerations for preopera-Figure 7　Late-onset AF free survival after CABG at Juntendo UniversityIn cases of transient postoperative atrial fibrillation, 20% will develop chronic atrial fibrillation 10 years later.tive imaging include the size, shape (sharp angles in the form of chicken wings, short neck <10 mm in the form of cauliflower), and presence of comb-like muscles, lobes, and nodes of the LAA. Closure of the LAA can be achieved by catheter-based lumen closure, surgical closure, or resection. Complex morphology can cause difficulties during the inser-tion of endocardial devices, and the selection of an appropriate method from surgical LAA closure/amputation is desirable. A recent study reported that hemodynamics could predict the risk of thrombus development in the LAA during normal sinus rhythm and AF according to LAA morphology36). The distribution of LAA forms was 30% cactus, 48% chicken wing, 19% windsock, and 3% cauliflower, with a higher incidence of stroke reported in forms other than the chicken wing37). In addition, it has been confirmed that closure of the LAA is more cost-effective than anticoagulation in preventing cerebral infarction in AF38).LAA Management for Patients with CABG The concept of stroke-free management for CABG surgery at Juntendo University refers to minimizing the invasiveness by OPCAB and preventing AF and cerebral infarction through prophylactic LAA amputation. Since 2012, we have performed LAA closure/amputation in all patients at Juntendo University