[Surgical closure of the left atrial appendage for thromboembolism prophylaxis].

Abstract

Background: The left atrial appendage (LAA) is the origin of thrombi in patients with atrial fibrillation (AF). Various techniques are available for surgical LAA occlusion. Current guidelines recommend surgical LAA closure as concomitant procedure in patients undergoing cardiac surgery or endoscopic or hybrid ablation for AF.

Objectives: This review article summarizes the current scientific evidence regarding surgical LAA closure and provides an outlook into its potential role in the future.

Materials and methods: A literature review was performed for LAA closure, indications, techniques, clinical outcomes, and ongoing studies.

Results: Different techniques are performed for surgical LAA closure. In a large randomizes study surgical LAA closure was associated with a reduction in thromboembolism in patients with AF. There are ongoing studies that examine the potential role of surgical LAA closure in patients with sinus rhythm and increased risk for stroke.

Conclusions: Surgical closure as a concomitant procedure in patients with AF undergoing cardiac surgery is now well established. It is unclear whether these patients require anticoagulation after successful closure. Currently, a few randomized trials are ongoing to evaluate whether prophylactic surgical LAA closure in patients with sinus rhythm and increased risk for stroke effectively reduces the incidence of stroke. At present, there are no data that support surgical LAA closure in patients with sinus rhythm and low risk for stroke.