Outcomes of cardiac surgery with left atrial appendage occlusion versus no Occlusion, direct oral Anticoagulants, and vitamin K Antagonists: A systematic review with Meta-analysis.

Surgical left atrial appendage occlusion (LAAO) is being used increasingly in the setting of atrial fibrillation but has been associated with procedural complications. This systematic review and meta-analysis compared the outcomes of surgical LAAO with those of no LAAO and the use of direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) using the PRISMA guidelines. A literature search was undertaken for relevant studies published between January 1, 2003, and August 15, 2021. Primary clinical outcomes were all-cause mortality, embolic events, and stroke. Secondary clinical outcomes included major adverse cardiac events (MACE), postoperative atrial fibrillation, postoperative complications, reoperation for bleeding, and major bleeding. There was a statistically significant 34% reduction in incidence of embolic events (odds ratio [OR] 0.66, 95% confidence interval [CI] 0.57-0.77, p < 0.001) and a significant 42% reduction in risk of MACE (OR 0.58, 95% CI 0.38-0.88, p = 0.01) in patients who underwent LAAO.Surgical LAAO has the potential to reduce embolic events and MACE in patients undergoing cardiac surgery for atrial fibrillation. However, complete replacement of DOACs and warfarin therapy with surgical LAAO is unlikely despite its non-inferiority in terms of minimizing all-cause mortality, embolic events, MACE, major bleeding, and stroke in patients on oral anticoagulation therapies.

A Case Report on Atypical Presentation of Metastatic Prostate Cancer.

The lung is a common site for metastatic cancers such as colorectal and breast cancer but an uncommon site for prostate cancer. The treatment modalities for primary and metastatic lung malignancies differ considerably; therefore, it is essential to distinguish between them. Here, we present a patient with solitary metastatic lung cancer with prostate as the primary source, which was initially considered a primary lung nodule considering his risk factors. The patient later developed other lung nodules and successfully underwent resection of these nodules with no bone involvement at the time. Follow-up computed tomography (CT) of the chest revealed two other new lung nodules and pleural effusion, and magnetic resonance imaging (MRI) of the pelvis showed bone involvement. The patient was started on gonadotropin-releasing hormone therapy with subsequent downtrending prostate-specific antigen (PSA). Although uncommon, prostate cancer can metastasize to the lungs; hence, clinicians must always have a high index of suspicion when a patient presents with a lung nodule, especially with a prior history of prostate cancer.

The Dilemma in the Management of Thromboembolic Disease in the Setting of Concomitant Aortic Pseudoaneurysm.

Ascending aortic pseudoaneurysm (AAP) is a rare and serious complication of cardiothoracic surgeries or blunt chest trauma. We present a patient with paroxysmal atrial fibrillation, acute right pontine stroke, and acute pulmonary embolism (PE) with an incidental AAP that precluded the use of anticoagulation and surgery. The case findings substantiate the need for a CT-based assessment of aortic pathology after coronary artery bypass grafting (CABG) in the asymptomatic patient to determine the most appropriate treatment modalities. However, the high cost of CT imaging and the potential radiation exposure challenge its routine use in high-risk patients.