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Outcomes of Patent Foramen Ovale Transcatheter Closure: Should a Short Aortic Rim Preclude Closure?
Stefanescu Schmidt, Ada C; Abrahamyan, Lusine; Muthuppalaniappan, Annamalar; Gorocica Romero, Ricardo; Ephrem, Georges; Everett, Karl; Lee, Douglas S; Osten, Mark; Benson, Leland N; Horlick, Eric M.
Afiliación
  • Stefanescu Schmidt AC; Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
  • Abrahamyan L; Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
  • Muthuppalaniappan A; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada.
  • Gorocica Romero R; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
  • Ephrem G; Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Hospital, Toronto, Ontario, Canada.
  • Everett K; Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
  • Lee DS; Gleneagles Hospital Penang, Pulau Pinang, Malaysia.
  • Osten M; Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
  • Benson LN; Mexican Institution of Social Security, UMAE No. 1, Merida, Yucatan, Mexico.
  • Horlick EM; Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
JACC Adv ; 2(2): 100257, 2023 Mar.
Article en En | MEDLINE | ID: mdl-38938308
ABSTRACT

Background:

The risk of erosion of an atrial septal closure device, in particular the Amplatzer Septal Occluder, has been described as higher in patients with a short aortic rim. Similar concern has been applied to patent foramen ovale (PFO) closure devices, but there are only rare reported cases of erosion. It may be that smaller devices are chosen due to fear of device erosion in PFO patients when this is not necessarily an issue.

Objectives:

The authors aimed to assess outcomes after PFO closure with the Amplatzer PFO device in patients with a short (<9 mm) aortic rim.

Methods:

We performed a retrospective analysis of PFO closure for any indication, between 2006 and 2017 at a quaternary center. Preprocedural transesophageal echocardiographic parameters including the aortic rim were remeasured. Long-term outcomes were obtained by linkage to provincial administrative databases.

Results:

Over the study period, 324 patients underwent PFO closure with the Amplatzer PFO device, with a mean age of 49.8 years; 61% had a short aortic rim (<9 mm). The most common indication was cryptogenic stroke (72%); those with longer aortic distance were more likely to have a non-stroke indication for closure, diabetes (15% vs 6.5%, P = 0.04), and heart failure (15.7% vs 4%, P < 0.001). Over a median 7 years of follow-up, there were no cases of device erosion or embolization requiring cardiac surgery.

Conclusions:

In a large cohort with long-term administrative follow-up (1,394 patient-years), implantation of an Amplatzer PFO device was performed safely even in patients with a short aortic rim.
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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Idioma: En Revista: JACC Adv Año: 2023 Tipo del documento: Article País de afiliación: Canadá

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Idioma: En Revista: JACC Adv Año: 2023 Tipo del documento: Article País de afiliación: Canadá