Potential uselessness and futility of left atrial appendage occlusion and patent foramen ovale closure in cardioembolic stroke
International guidelines indicate that interventional closure of left atrial appendage and patent foramen ovale may be considered in selected patients for stroke prevention. These procedures appear, however, from the published literature, at high risk of uselessness and futility in the single case, if not even capable to induce harm and adverse events. In fact, all reported systematic reviews and meta-analyses have not shown in a convincing manner the superiority of these procedures in stroke prevention, taking into account the occurrence of possible complications also, as compared with alternative medical treatment. On the basis of these considerations, it becomes very difficult to define always and unequivocally how adequate and complete was the information when given to each single candidate patient before the procedure by the Heart Team, the left atrial appendage occlusion Team or patent foramen ovale closure Team, potentially involved in conflict of interest. Before indicating these procedures, a complete diagnostic work-up should then be planned for each single patient to identify and treat not only one, but all concomitant risk factors and potential different cardioembolic sources. It could also be suggested to have, for each single candidate patient, a second independent opinion from physicians not involved in the procedure and possibly not operating in the same institution. This prudential approach could reduce in each single case the risk of uselessness, futility and even potential harm and adverse events of those procedures.