Abstract

HERNANDEZ-ESTEFANIA, R.; LEVY, B.  and  RABAGO, G.. Left atrial appendage as a source of stroke: to close (and how), or not to close (and why). Anales Sis San Navarra [online]. 2012, vol.35, n.1, pp.87-98. ISSN 1137-6627.  https://dx.doi.org/10.4321/S1137-66272012000100008.

Left atrial appendage is considered the main source of emboli in stroke for patients with atrial fibrillation. Oral anticoagulant therapy significantly reduces the risk of cerebral embolic events as compared with aspirin, but it is associated with bleeding complications, and it is not considered an standard of care. Closure of the left atrial appendage reduces the rate of thromboembolic events, and currently it is recommended in patients with atrial fibrillation submitted to mitral valve surgery. However the formation of emboli in those patients may be due to other causes and the roll of the atrial appendage currently has not very well defined. Moreover, neither all patients are candidates for oral anticoagulation, nor patients with oral anticoagulant maintain a adequate therapeutic range, which could be justify the formation of atrial thrombi. There are several methods to perform the closure of the appendage: endocavitary suture in concomitant mitral surgery, epicardial exclusion by stapling or clips, or endovascular occlusion by percutaneous devices. However the results seem inconclusive in regards of their effectiveness for complete occlusion of the appendage, safety, and efficacy to prevent cerebral embolic events. To increase the confusion, some authors reveal no clear benefit in suture closure, and even more others described an increased risk of thromboembolism. We present a review of the left atrial appendage closure for prevention of stroke and the different procedures as previously described.

Keywords : Atrial fibrillation; Occlusion; Left atrial appendage; Stroke; Anticoagulants.

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