Comparison of Outcomes after Device Closure with Transseptal Puncture and Standard Technique in Patients with Patent Foramen Ovale and Ischemic Events.

Abstract

OBJECTIVES:

The purpose of this study was to compare the effectiveness of device closure with the transseptal puncture and standard technique in patients with patent foramen ovale (PFO) and ischemic events.

METHODS:

Eighty-two consecutive patients (men: 60 patients, mean age: 45.2 years) who underwent PFO closure with the Amplatzer PFO Occluder were enrolled. PFO closure with the transseptal puncture was performed in 22 patients (transseptal puncture technique, group I). In the remaining patients (n = 60), PFO closure was performed with the standard technique (group II). The co-primary end points were the incidence of significant residual shunt on follow-up transesophageal echocardiography (TEE) and a composite of death, stroke, transient ischemic attack (TIA), and peripheral embolism.

RESULTS:

Baseline characteristics were similar between the two groups. On TEE, despite similar grade of interatrial right-to-left shunt, shunt at rest/septal hypermobility was less common in group I than in group II (40.9% vs. 72.9%, P < 0.010). The device was successfully implanted in all patients. On follow-up TEE, significant residual shunt was more common in group I than in group II (28.6% vs. 4.3%, P = 0.021). In addition, composite of death, stroke, TIA, or peripheral embolism was more common in group I than in group II (13.6% vs. 0%, P = 0.017) during the follow-up period (mean 25.4 months).

CONCLUSION:

Compared to the standard technique, PFO closure with the transseptal puncture technique showed higher incidence of residual shunt and ischemic events. Therefore, this technique might be considered in only highly selected patients as the last option.

• Authors: Jeonggeun Moon, Woong Chol Kang, Sihoon Kim, Myeong Gun Kim, Pyung Chun Oh, Yae Min Park, Wook-Jin Chung, Deok Young Choi, Ji Yeon Lee, Yeong-Bae Lee, Hee Young Hwang, Taehoon Ahn
• Journal: Journal of interventional cardiology (J Interv Cardiol) Vol. 29 Issue 4 Pg. 400-5 (Aug 2016) ISSN: 1540-8183 [Electronic] United States
• PMID: 27282763 (Publication Type: Comparative Study, Journal Article)
• Copyright: © 2016, Wiley Periodicals, Inc.

Topics

• Adult
• Brain Ischemia (epidemiology, etiology, prevention & control)
• Cardiac Catheterization (methods)
• Echocardiography, Transesophageal (methods)
• Female
• Follow-Up Studies
• Foramen Ovale, Patent (diagnosis, surgery)
• Humans
• Male
• Middle Aged
• Outcome and Process Assessment, Health Care (statistics & numerical data)
• Postoperative Complications (epidemiology, prevention & control)
• Prosthesis Implantation (adverse effects, instrumentation, methods, statistics & numerical data)
• Republic of Korea (epidemiology)
• Septal Occluder Device (adverse effects)