Percutaneous left appendage closure: A systematic review of safety and efficacy events

Introduction and objectives: The aim of the present study is to systematically review the success rate of percutaneous left atrial appendage closure, its efficacy and safety, and the incidence of peri-device leakage. Methods: A bibliographic search was performed using the Google Scholar, MEDLINE, EMBASE and Cochrane databases, restricting this search in English and collecting articles published until 2016. Our analysis was limited to those studies that met the following inclusion criteria: 1) studies with a prospective uni-center, prospective multicenter and retrospective multicentre design. 2) Studies that had a sample size >= 80 patients. Results: Data from the two clinical trials (PROTECT-AF and PREVAIL) suggest that percutaneous exclusion of the left atrial appendage provides a similar long-term rate of cerebrovascular embolic events and mortality compared to warfarin therapy. In the PROTECT AF study, an incidence of peri-device leak of 39% is documented. The remaining studies, which analyze patients with contraindications to anticoagulation and without a control group, report a significant rate of severe complications related to the procedure (up to 13,7%), the most frequent cause being pericardial effusion and/or cardiac tamponade. Conclusions: Percutaneous closure of the left atrial appendage is associated with a significant incidence of severe periprocedural complications and peri-device leak. (c) 2017 Sociedad Espanola de Cirugia Toracica-Cardiovascular. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license.