Purpose: In Kasugai City Hospital, we have introduced palliative care clinical pathway with a focus on decision-making support on the intention of recuperation location in addition to symptom relief. In this study, it is intended to explore the factors that make it difficult to home discharge of cancer inpatients with the intention of discharged home on the basis of the information on the clinical pathway. Methods: The subject patients were cancer inpatients who had expressed the intention of the discharge to the home during period from June 2014 to August 2015. We examined the medical records of the target patient retrospectively. Logistic regression analysis was performed in order to clarify the factors that make it difficult to home discharge. Results: Of 43 patients, 25 patients (58.1%) were discharged from the hospital to the home. As a result of logistic regression analysis (multivariate analysis), delirium and living alone have been extracted as the predictive factors that makes it difficult to home discharge. Conclusion: Delirium and living alone have been suggested as the factors that makes it difficult to home discharge of patients who wish to home discharge. Early detection and early treatment of delirium are important, and early collaboration between the hospital discharge support department and palliative care team for the living alone patient is also necessary.

Treating a thoracic aortic aneurysm (TAA) after coronary artery bypass graft (CABG) surgery requires an appropriate surgical procedure to preserve the functional graft. We present a case of hybrid procedure of thoracic endovascular aortic repair combined with a redo off-pump CABG via median sternotomy. The patient was a 76-year-old man with a history of CABG and abdominal aortic replacement in a different country. Chest computed tomography revealed a saccular-shaped aortic aneurysm in the distal aortic arch with diameter of 5.6 cm. Coronary angiography revealed theLIMA graft was patent but anastomosed to the diagonal branch and the left anterior descending artery (LAD) was totally occluded and was opacified through the right coronary artery. Significant ischemic change in the anteroseptal wall suggested a requirement of surgical revascularization of LAD. The chest was opened via re-midsternotomy. Then the 3 arch vessels were reconstructed with a trifurcated artificial graft attached to the ascending aorta and coronary artery bypass grafting was performed on the beating heart. Finally, the aneurysm was excluded by introducing a stent graft through the graft to zone 0. The patient's postoperative course was uneventful and he was discharged on postoperative day 16. A hybrid procedure via median sternotomy was useful in the surgery for TAA with the functional LIMA after CABG.