Key result
Transcatheter PFO closure left detectable right-to-left shunt in 55 of 120 patients at 4.9 years, with larger device size predicting residual shunt (OR 3.85; 95% CI 1.22-12.2).
Why the study?
What is the long-term rate of residual and recurrent right-to-left shunt after transcatheter PFO closure?
Observational (n=120)
No
What is the long-term rate of residual and recurrent right-to-left shunt after transcatheter PFO closure?
A significant proportion of patients experience recurrent or residual right-to-left shunts up to 5 years after transcatheter PFO closure, highlighting the need for long-term follow-up.
Residual shunts persist years after PFO closure; leaves open whether device sizing affects outcomes in prospective trials.
OBJECTIVES: Assess the evolution of right-to-left shunt (RLS) after transcatheter patent foramen ovale (PFO) closure. BACKGROUND: Despite the high number of interventional procedures performed worldwide, limited systematic data on the long-term abolition of RLS after percutaneous closure are available. METHODS: All patients treated at our Institution between February 2001 and July 2009 were included in this single center, prospective study, and were asked to repeat late contrast transcranial Doppler (cTCD). Rate of complete closure, residual RLS (i.e., a shunt that persists after closure), and recurrent RLS (i.e., a shunt that reappears after a previous negative cTCD) was assessed. RESULTS: Long-term follow-up was completed in 120 patients (56% male). RLS was still detectable 4.9 ± 2.3 years (range 1.3-10.3) after the procedure in 55 patients; 20 (17%) had residual RLS and 35 (29%) had recurrent RLS. Multivariate analysis revealed that significant predictors of residual RLS included post-procedural shunt at transesophageal echocardiography (OR 3.07, 95%CI 0.97-9.7), use of a bigger device (35 vs 25 mm, OR 3.85, 95%CI 1.22-12.2) and length of follow-up (OR 0.75, 95%CI 0.57-0.98), while only length of follow-up (OR 0.77, 95%CI 0.62-0.95) was associated with recurrent RLS. Neurological recurrences (1 stroke, 6 transient ischemic attacks) were equally distributed between the groups. CONCLUSION: A significant number of recurrent and residual shunts may be observed by cTCD up to 5 years after PFO closure. Management of late RLSs includes periodic re-evaluation, exclusion of device-induced complications or secondary sources of RLS, and optimization of antithrombotic treatment with or without a second intervention.
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Cheli et al. (2015) conducted an observational in Patent foramen ovale (n=120). Transcatheter patent foramen ovale (PFO) closure was evaluated on Rate of complete closure, residual right-to-left shunt (RLS), and recurrent RLS. Transcatheter PFO closure left detectable right-to-left shunt in 55 of 120 patients at 4.9 years, with larger device size predicting residual shunt (OR 3.85; 95% CI 1.22-12.2).
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