SPC365

Improving patient selection for percutaneous suture-mediated patent foramen ovale closure: the SWAT criteria

Session: SESSÃO DE COMUNICAÇÕES ORAIS 09 - CARDIOLOGIA DE INTERVENÇÃO/ESTRUTURAL
Speaker: Inês Gomes Campos

Congress: CPC 2025
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.3 Non-coronary Cardiac Intervention
Session Type: Comunicações Orais
FP Number: ---
Authors: Inês Gomes Campos; Joel Monteiro; Bruno Bragança; Inês Oliveira; Mauro Moreira; José Luis Ferraro; Ana Rodrigo Costa; Rafaela G. Lopes; Marta Tavares Silva; João Carlos Silva; Rui André Rodrigues; Aurora Andrade

<p style="text-align:justify"><span style="font-size:medium"><span style="color:#000000"><strong>Background</strong><span style="font-family:Calibri,sans-serif">: Percutaneous suture-mediated patent foramen ovale (PFO) closure with NobleStitch EL has demonstrated high</span><span style="color:black; font-family:Calibri,sans-serif"> immediate success rates and absence of significant procedural complications</span><span style="font-family:Calibri,sans-serif">. However, long-term follow-up results show non-negligible rates of significant (grade</span><span style="font-family:Symbol">&gt;=</span><span style="font-family:Calibri,sans-serif">2) residual right-to-left shunt (RLS).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Aim</strong>: To identify predictors of significant residual RLS in order to improve patient selection for NobleStitch EL procedure.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods</strong>: Single-center retrospective observational registry of consecutive patients admitted for PFO closure with NobleStitch EL between January 2020 and September 2024. Patient and baseline PFO echocardiographic characteristics were collected. Patients were followed up to 2.5 years (mean 533 <span style="font-family:Symbol">&plusmn;</span> 398 days). The primary outcome was significant residual RLS during follow-up. Predictors were identified using logistic regression and were combined in an additive model. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results</strong>: Among 79 patients included (mean age 48.5<span style="font-family:Symbol">&plusmn;</span>12.6 years, 55.7% female), 95% were referred for PFO closure for cryptogenic stroke and transit ischemic attack, with high RoPE score (median 6). PFO was <em>tunnel-like</em> in 81.2%, with median length 10.0mm (IQR 8.3), width 3.0mm (IQR 2.0) and atrial septal aneurysm in 41.6% of the patients. Baseline spontaneous RLS was present in 87.8% patients.</span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="color:#000000"><span style="font-family:Calibri,sans-serif">During follow-up, 30 patients (40.0%) had significant residual RLS. The variables identified as predictors for significant residual RLS were presence of </span><em>tunnel-like </em><span style="font-family:Calibri,sans-serif">PFO, PFO width (optimal cutoff</span><span style="font-family:Symbol">&gt;=</span><span style="font-family:Calibri,sans-serif">4mm), presence of atrial septal aneurysm and presence of baseline spontaneous shunt. </span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="color:#000000"><span style="font-family:Calibri,sans-serif">An additive model was created &ndash; the SWAT criteria (Spontaneous shunt, Width</span><span style="font-family:Symbol">&gt;=</span><span style="font-family:Calibri,sans-serif">4mm, Aneurysm, Tunnel) &ndash; showing very good prediction accuracy (AUC 0.822; 95% IC 0.709-0.935). </span><span style="color:black; font-family:Calibri,sans-serif">Patients with SWAT 0 or 1 showed significant lower residual RLS at follow-up than patients with SWAT 3 or 4 (9.1% vs 78.3%, p&lt;0.001).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion</strong>: This study represents the largest and longest national registry of patients undergoing PFO closure with NobleStitch EL. Our findings indicate that long-term significant RLS is strongly associated with specific anatomical aspects of the atrial septum, emphasizing the critical role of detailed PFO characterization in suture-mediated closure. The SWAT criteria demonstrated high predictive accuracy for significant residual RLS during follow-up, offering a practical tool for identifying suitable candidates for this procedure.</span></span></span></p>