Naqibullah Mirzada1, Per Ladenvall2, Per-Olof Hansson2, Peter Eriksson2, Mikael Dellborg2. 1. Center for Adults With Grown-Up Congenital Heart Disease (GUCH), Sahlgrenska University Hospital/Östra, Sweden; Institute of Medicine, Dept. of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, Gothenburg University, Sweden. Electronic address: naqibullah.mirzada@vgregion.se. 2. Center for Adults With Grown-Up Congenital Heart Disease (GUCH), Sahlgrenska University Hospital/Östra, Sweden; Institute of Medicine, Dept. of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, Gothenburg University, Sweden.
Abstract
AIMS: Observational studies favor percutaneous closure of patent foramen ovale (PFO) over medical therapy to reduce the risk of recurrent stroke, whereas randomized clinical trials have not shown significant differences. This study aims to compare long-term outcomes of PFO closure versus non-closure. METHODS AND RESULTS: Patients with PFO and stroke considered for PFO closure were invited to a long-term clinical follow-up. Of the 314 patients, 151 (48%) were accepted for closure and 163 (52%) were not accepted (mean age 50 vs. 58 years). The cumulative incidence of all-cause mortality, stroke or transient ischemic attacks (TIAs) for closure vs. non-closure under a mean follow-up time of five years was 10.6% (16 events) vs. 12.9% (21 events), p=0.53. Six patients, 3.7% vs. 3.6%, died in each group, but no deaths were associated with PFO closure, recurrent stroke or TIA. The incidence of recurrent stroke or TIA for closure vs. non-closure was 6.6% (10 events) vs. 9.2% (15 events), p=0.63. The respective event rates for stroke were 3.9% (6 events) vs. 5.5% (9 events), p=0.50 and for TIA, 2.6% (4 events) vs. 3.7% (6 events), p=0.59. CONCLUSION: PFO closure was associated with a low risk of recurrent events; however, compared to the non-closure group, no significant differences could be demonstrated. Careful patient selection can avoid under- as well as over-treatment of PFO patients.
AIMS: Observational studies favor percutaneous closure of patent foramen ovale (PFO) over medical therapy to reduce the risk of recurrent stroke, whereas randomized clinical trials have not shown significant differences. This study aims to compare long-term outcomes of PFO closure versus non-closure. METHODS AND RESULTS:Patients with PFO and stroke considered for PFO closure were invited to a long-term clinical follow-up. Of the 314 patients, 151 (48%) were accepted for closure and 163 (52%) were not accepted (mean age 50 vs. 58 years). The cumulative incidence of all-cause mortality, stroke or transient ischemic attacks (TIAs) for closure vs. non-closure under a mean follow-up time of five years was 10.6% (16 events) vs. 12.9% (21 events), p=0.53. Six patients, 3.7% vs. 3.6%, died in each group, but no deaths were associated with PFO closure, recurrent stroke or TIA. The incidence of recurrent stroke or TIA for closure vs. non-closure was 6.6% (10 events) vs. 9.2% (15 events), p=0.63. The respective event rates for stroke were 3.9% (6 events) vs. 5.5% (9 events), p=0.50 and for TIA, 2.6% (4 events) vs. 3.7% (6 events), p=0.59. CONCLUSION: PFO closure was associated with a low risk of recurrent events; however, compared to the non-closure group, no significant differences could be demonstrated. Careful patient selection can avoid under- as well as over-treatment of PFO patients.
Authors: Francesco Versaci; Giampiero Vizzari; Domenico Sergi; Giuseppe Andò; Antonio Trivisonno; Francesco Romeo Journal: Clin Case Rep Date: 2017-10-26
Authors: Gary Tse; William K K Wu; Jenny Chi Ling Lai; Mengqi Gong; George Bazoukis; Wing Tak Wong; Sunny Hei Wong; Konstantinos Lampropoulos; Adrian Baranchuk; Lap Ah Tse; Yunlong Xia; Guangping Li; Martin C S Wong; Yat Sun Chan; Nan Mu; Mei Dong; Tong Liu Journal: F1000Res Date: 2017-12-27