A female patient with cerebral ischemia after percutaneous kyphoplasty due to a paradoxical embolism via a persistent foramen ovale (PFO) - is a perioperative transesophageal echocardiography (TOE) helpful in the context of cardiac risk stratification?

Patent foramen ovale and perioperative stroke in noncardiac surgery: a systematic review and meta-analysis

“…Nine studies (n¼21 256 783) were retrospective and two studies (n¼299) were prospective. 22,30 Nine studies were performed in the USA (n¼21 256 783), one in Canada (n¼202), 30 and one in Germany (n¼97). 22 Six studies were multicentric, whilst five studies were single centre.…”

“…22,30 Nine studies were performed in the USA (n¼21 256 783), one in Canada (n¼202), 30 and one in Germany (n¼97). 22 Six studies were multicentric, whilst five studies were single centre. One (n¼97) was published only in abstract format.…”

“…One (n¼97) was published only in abstract format. 22 Records identified from: -MEDLINE ( Two reports 24,31 reported longer follow-up referring to the original study. 13,25 Three studies (n¼20 449 344) included patients undergoing mixed noncardiac surgery, four studies (n¼806 262) hip or knee arthroplasty, two studies (n¼1285) liver transplantation, 25,29 one study (n¼831) double-lung transplantation, 23 and one study (n¼97) percutaneous kyphoplasty.…”

“…13,25 Three studies (n¼20 449 344) included patients undergoing mixed noncardiac surgery, four studies (n¼806 262) hip or knee arthroplasty, two studies (n¼1285) liver transplantation, 25,29 one study (n¼831) double-lung transplantation, 23 and one study (n¼97) percutaneous kyphoplasty. 22 Six studies (n¼21 254 504) used a multivariate analysis adjusted for confounders, and propensity score matching analysis was reported in four of them (35 238 matched patients). Five studies did not report adjusted analyses (n¼260 588).…”

“…Five studies were judged to be of good methodological quality. 21,26e28,31 Six studies were judged to be of poor methodological quality 14,22,23,25,29,30 ; the main issue was the limitation in comparability between groups because of lack of an adjusted analysis (Supplementary Table 5).…”