Influence of procedural timing on the preventive yield of percutaneous patent foramen ovale closure. in Open heart / Open Heart. 2024 Oct 15;11(2):e002870. doi: 10.1136/openhrt-2024-002870.

2024
ASL Torino 3
AOU San Luigi di Orbassano

Tipo pubblicazione

Multicenter Study

Autori/Collaboratori (24)Vedi tutti...

Gabani R
Cardiology, Hospital Universitario de Salamanca, Salamanca, Spain.
Valero E
Cardiology, Rivoli Hospital, Rivoli, Italy.
Perez de Prado A
Cardiology, San Luigi Gonzaga University Hospital, Orbassano, Italy.

et alii...

Abstract

BACKGROUND: The benefit of patent foramen ovale closure (PFOC) ?9 months after a cryptogenic stroke has been demonstrated in several randomised clinical trials. There is, however, insufficient data to support PFOC in non-recent cryptogenic strokes. AIMS: The objective of the study was to evaluate the effectiveness of PFOC in relation to the time since the patient's most recent cryptogenic cerebrovascular event (CVE) or systemic embolism (SE). METHODS: We conducted a multicentre, retrospective cohort study with international participation, to assess the results of an early closure (EC, <9 months) for secondary prevention versus a delayed closure (DC, ?9 months). Recurrence of CVE/SE following PFOC was evaluated as the primary endpoint. RESULTS: 496 patients were included (65% in the EC and 35% in the DC group). With the exception of a larger defect size in the DC group (tunnel width 6 (4-14) vs 12 (6-16) mm, p=0.005), similar clinical and echocardiographic baseline features were observed between the groups. No differences were observed regarding the type of devices used for PFOC, procedural success rate (99.4 in EC vs 98.8% DC group) and periprocedural complications (2.1% vs 0.8%). Median follow-up was 2.0 (1.2-4.2) years in the whole study population. Recurrence of CVE/SE (3.9% vs 2.6%, p=0.443), death (1.4% vs 1.0%, p=0.697), residual shunt 12 months after PFOC, or antithrombotic treatment strategy were comparable in both groups during follow-up. A subanalysis comparing very delayed PFOC (?24 months) also showed no differences in recurrence (4.2% in the <24-month vs 3.4% in the ?24-month group, p=0.770). CONCLUSION: Patients undergoing PFOC before and after 9 months after the index event had a comparable recurrence rate of CVE/SE. These findings suggest that PFOC might be recommended in cryptogenic CVE/SE which are more remote than 9 months.

Accesso banca dati bibliografica

PMID : 39414310

DOI : 10.1136/openhrt-2024-002870

Keywords

Aged; Time-to-Treatment; Septal Occluder Device; Secondary Prevention/methods; Recurrence; Treatment Outcome; Time Factors; Cardiac Catheterization/methods/adverse effects/instrumentation; Middle Aged; Retrospective Studies; Female; Male; Foramen Ovale, Patent/complications/therapy/surgery; Humans; Risk Factors; Follow-Up Studies; Adult; Heart Defects, Congenital; Heart Septal Defects, Atrial; Stroke;