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Sex differences in patent foramen ovale closure: impact on outcomes and complications
Session:
SESSÃO DE POSTERS 58 – TROMBOEMBOLISMO
Speaker:
Mariana Rodrigues Simões
Congress:
CPC 2025
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Cartazes
FP Number:
---
Authors:
Mariana Rodrigues Simões; Ana L. Silva; Tatiana Pereira Dos Santos; Gonçalo Terleira Batista; Manuel Santos; José L. Martins; Luís Paiva; Marco Costa; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><u>Introduction</u>: Patent foramen ovale (PFO) is often detected in younger patients with stroke of undetermined etiology. The percutaneous PFO closure demonstrate effectiveness in reducing recurrent strokes but there is a notable absence of analysis of variances between sexes in this regard. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><u>Methods</u>: We conducted a one-centre, retrospective observational study, reviewing all patients who underwent percutaneous PFO closure between September 2003 and June 2023. Informatized clinical files were reviewed, and statistical analysis was performed using SPSS.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><u>Results</u>: A total of 378 patients were included and 56.1% were female. 345 patients underwent PFO closure after undetermined etiology stroke<strong>. </strong>The mean follow-up time was 65(±54) months. The number of women who underwent PFO closure after stroke were 190. The mean age among women was 48(±10,70) years, whereas for men, it was 47,13 (± 11,28) years. Although women showed higher occurrence of arterial hypertension (n=59 vs n=45), diabetes (n=17 vs n=12), hyperlipidemia (n=81 vs n=74) and overweight (n=41 vs n=38), none of these differences reached statistical significance. Significant differences were observed: women had higher risk of paradoxical embolism (roPE) score (6,76±1,45 vs 6,56±1,75, p=0,003), a lower prevalence of sleep apnea diagnosis (3,51% vs 11,8%, p=0,005) and smoke less frequently (9,95% vs 28,19%, p<0,001). No differences were found among high risk PFO features. Following PFO closure, females exhibited a higher incidence of residual shunt within the first month after device implantation, assessed by transthoracic echocardiography: 5,08% vs 0,73%; OR = 7.29 (0.91-58.22); p=0,047. Women experienced 3 procedural complications (2 vascular access complication and 1 device embolization) versus 1 in men (a vascular access complication in men), but the difference wasn’t statistically significant. Long-term outcomes showed no difference between the composite of transient ischemic attack (TIA)/stroke recurrence, despite women having more events (n=4 vs n=2). Throughout the follow-up period, seven patients (4 women and 3 men) developed atrial fibrillation and six patients died (3 patients of each group).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><u>Conclusion</u>: Women were associated with higher incidence of residual shunt within the first month. Besides, they seem to be at a higher risk of procedural complications. Despite women have presented more TIA/stroke recurrence, long-term outcomes have shown no difference between genders. </span></span></p>
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