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Published on: February 26, 2013
Association between patent foramen ovale morphology and clinical outcomes following transcatheter closure
Lijie Sun1, Zhenxing Fan2, Jing Gao2
1Department of Geriatrics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China.
Insights
Complex patent foramen ovale (PFO) anatomy is linked to increased adverse events after transcatheter closure. This study found complex PFO morphology independently associated with higher risks, highlighting the importance of PFO variations in patient outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Structural Heart Disease
Background:
- Anatomic variations of patent foramen ovale (PFO) are common.
- Limited research exists on the impact of PFO morphology on clinical outcomes after transcatheter closure.
Purpose of the Study:
- To explore the association between PFO morphology and clinical outcomes following transcatheter PFO closure.
- To investigate if complex PFO anatomy increases the risk of adverse events.
Main Methods:
- Prospective enrollment of consecutive patients with cryptogenic stroke undergoing PFO closure (September 2019 - April 2023).
- Categorization of patients into simple and complex PFO morphology groups.
- Comparison of composite events (mortality, recurrent stroke, residual shunt, symptomatic atrial fibrillation) over a median 24-month follow-up.
Main Results:
- 91/247 (36.8%) patients had complex PFO, characterized by older age, higher male proportion, longer procedure times, and increased use of delivery sheath-assisted crossing.
- Complex PFO group showed significantly higher estimated event rates (27.9% vs. 11.3%) compared to the simple PFO group.
- Complex PFO remained an independent predictor of composite adverse events (HR 2.10, P=0.034) after multivariable adjustment.
Conclusions:
- Complex PFO morphology is associated with a higher risk of adverse events after transcatheter closure.
- PFO anatomy is a crucial factor influencing outcomes in patients undergoing PFO closure.
- Further research may refine risk stratification based on PFO morphology.
Background:
Anatomic variations of the patent foramen ovale (PFO) are commonly observed, yet limited research has investigated their impact on clinical outcomes following transcatheter closure. We aimed to explore the association between PFO morphology and clinical outcomes.
Methods:
Consecutive patients with cryptogenic stroke who underwent PFO closure were prospectively enrolled at a single center from September 2019 to April 2023. Patients were categorized into simple and complex groups based on PFO morphology. Composite events were compared between the two groups during a median follow-up of 24 months, including all-cause mortality, recurrent stroke, residual moderate or severe shunt, and symptomatic atrial fibrillation.
Results:
A total of 247 patients were enrolled, with a mean age of 41.9 ± 13.0 years and 45.3% males. Ninety-one (36.8%) patients had complex PFO. These individuals were older (45.4 ± 12.5 years vs. 39.9 ± 12.9 years; P = 0.001), more males (56.0% vs. 39.1%; P = 0.010), had longer procedure times (54 ± 32 min vs 46 ± 29 min; P = 0.044), and had a higher rate of using delivery sheath-assisted crossing of the PFO (22.0% vs 12.8%; P = 0.040) than those with simple PFO. The estimated event rates were 27.9% and 11.3% (P = 0.006) in the complex and simple PFO groups, respectively (12.9 events and 5.2 events per 100 person-years; P = 0.001). After adjusting for age, sex, hypertension, diabetes, smoking, device type, and left atrial diameters, complex PFO remained independently associated with composite events (HR 2.10, 95%CI 1.06-4.17, P = 0.034).
Conclusions:
Patients with complex PFO may suffer from a higher risk of adverse events following transcatheter PFO closure.
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