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Updated: Sep 13, 2025
Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
Published on: December 23, 2022
Effectiveness of PFO Closure in Preventing Cerebrovascular Events: A 13-Year Retrospective Cohort Study
Pardis Javadian1, Reza Heydarzadeh1,2, Reza Golchin Vafa1,2
1Shiraz University of Medical Sciences, Shiraz, Iran.
Insights
Patent foramen ovale (PFO) closure showed no significant benefit in preventing major adverse cardiovascular events (MACE) or cerebrovascular events in patients, irrespective of prior stroke history. Further research is needed to identify specific patient groups who may benefit from PFO closure.
Area of Science:
- Cardiology
- Neurology
- Vascular Medicine
Background:
- The link between patent foramen ovale (PFO) and cerebrovascular events or major adverse cardiovascular events (MACE) requires further investigation.
- Understanding the impact of PFO closure on cardiovascular and cerebrovascular outcomes is crucial for patient management.
Purpose of the Study:
- To evaluate the effectiveness of patent foramen ovale (PFO) closure versus non-closure in reducing the risk of MACE and cerebrovascular events.
- To compare outcomes in patients with and without a history of cerebrovascular accidents (CVA).
Main Methods:
- A retrospective cohort study involving patients under 60 with PFO diagnosed between 2010 and 2023.
- Data collected via patient interviews on MACE occurrence (MI, CVA/TIA, DHF, cardiac death) post-diagnosis or PFO closure.
- Analysis of MACE and new CVA incidence in patients with and without prior CVA history, comparing PFO closure and non-closure groups.
Main Results:
- In patients with prior CVA (n=122), MACE incidence was 10.6% with no significant difference between PFO closure and non-closure groups (p=0.430).
- New CVA occurrences also showed no significant difference between groups (p=0.479) in patients with prior CVA.
- Among patients without prior CVA (n=58), MACE incidence was 8.6%, with no significant difference in MACE rates (p=0.192) or new CVA occurrences (p=0.328) between closure groups.
Conclusions:
- Patent foramen ovale (PFO) closure did not demonstrate a clear protective benefit against MACE in this 13-year study population.
- The effectiveness of PFO closure appears consistent regardless of a patient's history of cerebrovascular accidents (CVA).
- Further research is essential to identify specific patient subgroups that may benefit from PFO closure interventions.
Background:
The association between patent foramen ovale (PFO) and cerebrovascular events and major adverse cardiovascular events (MACE) is less explored.
Aims:
This study evaluates the effectiveness of PFO closure versus non-closure on the risk of MACE and cerebrovascular events in patients with or without a CVA history.
Methods:
This retrospective cohort study included patients diagnosed with PFO who were younger than 60 years old and referred to the Professor Kojuri Cardiovascular Clinic between 2010 and 2023. Patients were interviewed for the occurrence of MACEs post-diagnosis or closure. The MACE components consisted of myocardial infarction (MI), cerebrovascular accidents or transient ischemic attacks (CVA/TIA), decompensated heart failure (DHF), and cardiac death.
Results:
Among 122 participants with prior CVA, MACE incidence was seen at 13 (10.6%), including eight new CVAs (6.6%), three new MI events (2.5%), and two new cases of acute DHF (1.6%). No significant differences in MACE incidence rates were found between PFO closure and non-closure groups (p = 0.430), nor in new CVA occurrences (p = 0.479). Among 58 patients without prior CVA, MACE incidence was five (8.6%), including two new MIs (3.4%), two new cases of acute DHF (3.4%), and one new CVA (1.7%). Similarly, no significant differences were observed in MACE rates (p = 0.192) or new CVA occurrences (p = 0.328) between closed and non-closed groups.
Conclusion:
Our findings over a period of 13 years suggest that PFO closure may not provide a clear protective benefit against MACEs in this population, regardless of prior CVA history, highlighting the need for further research to identify specific patient subgroups that might benefit from this intervention.
