68-2

17/110

OR (95%CI)2.05(0.92-4.60)1.30(0.62-2.71)1.54(0.67-3.57)reference3.26(1.29-8.26)1.22(0.43-3.49)0.86(0.18-4.14)undergoing CABG, even in OPCAB surgery. Endo et al. reported that the intima in the left atrium was smooth, precise, and completely covered after LAA amputation (Figure 8)39). In a survey of 2,268 patients in our department, LAA closure/amputation was associated with no increase in POAF (26%) or bleeding. Furthermore, it effectively prevented cerebral infarction in patients with POAF in the long term and contributed to stroke-free manage-ment (Table 5)40).Recently, we have also begun to intervene in the autonomic plexus around the heart to prevent POAF. The ganglionated plexus, an autonomic plexus around the heart, contains a certain percentage of parasympathetic and sympathetic nerves, both of which interact with the atrial muscle. The ganglionated plexus is called the “brain Figure 8　Neointima on the scar site after the left atrial appendage amputationBlack arrow is thrombi in Left atrium. Red arrow is neointima.Reprinted from Endo D, Yamamoto T, Kuwaki K et al: Neointima on the scar site after the left atrial appendage amputation. J Card Surg, 2019; 34: 855.Peripheral arterial disease (yes=1)eGFR<60ml/min.1.73m2 (yes=1)Previous stroke (yes=1)LAA amputation(-)/POAF(-)LAA amputation(-)/POAF(+)LAA amputation(+)/POAF(-)LAA amputation(+/POAF(+)LAA: Left atrial appendage. POAF: Postoperative atrial fibrillationTable 5　Late-onset AF free survival after CABG at Juntendo Universityof the heart” because it independently acts on the atrial muscle and is distributed in mainly five loca-tions around the left atrium41, 42). (Figure 9) We have performed resection of the Marshall ligament and the ganglionated plexus located in the upper left atrial wall from the left superior pulmonary vein. The resected tissue showed exchange ganglion and sympathetic nerve fibers, and we are continuing follow-up studies to determine the preventive effect on AF (Figures 10 and 11).It was found that renal dysfunction, especially in hemodialysis patients, is frequently complicated by AF43), and more than 11% of hemodialysis patients over 75 years of age have chronic AF (Figure 12)44). Cerebral hemorrhage and stroke are common in dialysis patients because of hypertension caused by renal failure and arteriosclerotic changes in cere-MultivariateP value0.080.490.310.010.720.85109