The left atrial appendage is considered the main source of emboli in strokes in
patients with atrial fibrillation. Oral anticoagulant therapy significantly
reduces the risk of cerebral embolic events compared to aspirin, but it is
associated with bleeding complications, and is not always used. Closure of the
left atrial appendage reduces the rate of thromboembolic events, and it is
currently recommended in patients with atrial fibrillation submitted to mitral
valve surgery. However, the formation of emboli in these patients may be due to
other causes, as the role of the atrial appendage could be less important than is
assumed. Moreover, not all patients are candidates for oral anticoagulation, and
not all are kept in a proper therapeutic range, which could justify the formation
of atrial thrombi. There are several methods for performing the closure of the
appendage: direct suture in concomitant mitral surgery, epicardial exclusion by
stapling or clips, or endovascular occlusion by percutaneous application.
However, the results seem inconclusive with regards to their effectiveness for
complete occlusion of the appendage, safety, and efficacy in preventing cerebral
embolic events. To add to the confusion, some authors reveal no clear benefit in
suture closure, and even describe an increased risk of thromboembolism. We
present a review of left atrial appendage closure for the prevention of strokes,
as well as the different procedures described above