Left Atrial Appendage Exclusion for Prophylactic Stroke Reduction Trial

Inclusion Criteria: * Subjects ≥ 18 years of age * Documentation of any of the following clinical criteria: * CHA2DS2-VASc ≥ 4 with age ≥ 65 * CHA2DS2-VASc ≥ 4 with significant left atrium enlargement or elevated NT-proBNP * CHA2DS2-VASc = 3 with age ≥ 75 * CHA2DS2-VASc = 3 with significant left atrium enlargement or elevated NT-proBNP * CHA2DS2-VASc score = 2 with age ≥ 65 and significant left atrium enlargement or elevated NT-proBNP Exclusion Criteria: * Clinically significant atrial fibrillation or atrial flutter: * Anytime in the past and * Documented by an electrocardiographic recording and * Episode lasting 6 minutes or longer1\* * Prior procedure involving opening the pericardium or entering the pericardial space * Prior LAA occlusion, exclusion, or removal (surgical or percutaneous) * Planned cardiac surgical procedure using non-sternotomy approaches o Partial sternotomies will be allowed. * Patients whose planned procedure is a heart transplant or implantation of any ventricular assist devices * Active endocarditis * Active systemic infection at the time of cardiac surgery requiring antibiotics, including known SARS-CoV2 infections regardless of symptoms * Known allergy to Nitinol or nickel sensitivity * Known medical condition with expected survival of less than 1 year * Other comorbidities that in the investigator's opinion make the subject unsuitable candidate to complete the protocol required visits. * Current enrollment in an investigation or trial or an investigational devices or investigational drug that would interfere with this trial. * Mental impairment or other psychiatric conditions which may not allow the patient to understand the nature, significance, and scope of the trial. * Pregnancy * Known severe symptomatic carotid disease