SPC365

Residual Shunt after Patent Foramen Ovale Closure: Predictors’ and Its Impact on Long-term Outcomes

Session: Comunicações Orais (Sessão 9) - Intervenção Cardíaca Coronária e Estrutural 2 - Vários Tópicos
Speaker: Carolina Saleiro

Congress: CPC 2022
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.4 Interventional Cardiology - Other
Session Type: Comunicações Orais
FP Number: ---
Authors: Carolina Saleiro; Sara Matos; Telma Alves; Diana de Campos; Manuel Oliveira-Santos; Gustavo Santo; Fernando Silva; João Sargento Freitas; Luís Paiva; Marco Costa; Lino Gonçalves

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Background:</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif"> Percutaneous closure is the standard therapy when a high-risk patent foramen ovale (PFO) is considered to have an important pathogenic role in stroke. Residual shunt after closure represents a problem in some patients. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Aim:</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif"> To assess the predictors of residual shunt at three-six months after PFO closure. To assess the impact of residual shunt on stroke/transitory ischemic attack (TIA) recurrence, headache symptoms relief or need for re-intervention. &nbsp;</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Methods:</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif"> 336 consecutive patients who underwent PFO closure between 09/2003 and 11/2021 were included in the analysis. Demographic, imagological, and procedural data were collected. Median follow-up time was 12 [6-29] months.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Results:</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif"> Mean age was 47&plusmn;11years old, with 58% female patients. Comorbidity with CV risk factors was low, but almost a quarter reported headache. The main indication for closure was previous stroke/TIA (91%). Mean number of PFO risk characteristics was 4&plusmn;2 (aneurismatic septum 41.8%, moderate shunt 14.5%; severe shunt 68.5%; septum hypermobility 41.1%; long tunnel 73.6%; Chiari web 0.9%; large PFO 62.3%). Amplatzer device was used more frequently (71.4%) followed by Premere (15.2%), Figulla (4.2%), Solysafe (1.5%), Gore Cardioform (0.3%) and CeraFlex (0.3%). Remaining shunt after the procedure was confirmed by colour doppler in 0.6% of the patients 24 hours after the procedure and in 3.6% one-month after. Evaluation with agitated saline echocardiography at three to six months was performed in 251 patients and residual shunt was confirmed in 7.7%. Grade 1 shunt was present in 43.5% of the cases, grade 2 in 21.7% and grade 3 in 34.8%. At one-year, the rate of residual shunt decreased to 3.6%. The anatomical characteristics of the PFO were not predictors of residual shunt, either when analysed in isolation or as cumulative number of risk characteristics (P=0.51). However, despite the small sample size, there is an association between the Occluder device and residual shunt (P=0.001, Table 1). Stroke/TIA recurrence rate was 1.5% and residual shunt was not a predictor of recurrence (P=0.48). In a subgroup of patients with headache, residual shunt was not related to the absence of symptoms relief (P=0.24). Reintervention rate was 0%.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Conclusion: </span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Incidence of residual shunt after PFO closure at three to six months was 7.7%. There is an association between the Occluder device and risk of residual shunt. Residual shunt did not affect stroke recurrence, headache symptom relief or the need for re-intervention.&nbsp; <strong>&nbsp;</strong></span></span></span></span></p>