Recurrent and Residual Shunts After Patent Foramen Ovale Closure: Results From a Long‐Term Transcranial Doppler Study

Cheli, Martino; Canepa, Marco; Brunelli, Claudio; Bezante, F.A.C.C. Gian Paolo; Favorini, Serena; Rollando, Daniela; Sivori, Giorgia; Viani, Erica; Finocchi, Cinzia; Balbi, Manrico

doi:10.1111/joic.12255

Cited by 18 publications

(7 citation statements)

References 38 publications

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“…All patients underwent contrast transcranial Doppler at FU. There was a residual RLS in 29% at 1 year and 17% at 5-years FU 17. These results are comparable to our findings.…”

supporting

confidence: 92%

Percutaneous patent foramen ovale closure using the Occlutech Figulla device: More than 1,300 patient‐years of follow up

Snijder

Renes

Suttorp

et al. 2018

Cathet Cardio Intervent

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Objective: To evaluate the safety and efficacy of the Occlutech patent foramen ovale (PFO) device at long-term follow-up (FU).Background: The Occlutech device has been proven safe and effective six-months after percutaneous PFO closure. We describe the safety and efficacy after more than 1,300 patient-years of FU.Methods: All consecutive patients who underwent PFO closure between October 2008 and December 2015 were included. All complications were registered. Residual right-to-left shunt (RLS) was diagnosed using contrast transthoracic echocardiography and graded as minimal, moderate, or severe.Results: In total, 250 patients (mean age 53.5 AE 10.7 years, 46.8% female) underwent percutaneous PFO closure using the Occlutech device. Mean FU was 5.9 AE 1.8 years, a total of 1,345 patient-years. Transient ischemic attack (TIA) or stroke was the main indication for closure (89.6%). Implantation was successful in 100%, no major complications occurred. Minor complications were inguinal hematoma in 16 patients (6.4%), pericardial effusion without the need for intervention in one patient (0.4%) and a supraventricular tachycardia in one patient (0.4%). A moderate or large shunt at one-year follow up was present in 5.9%. A cerebrovascular vascular event occurred in 2.0% at 1-year FU (four TIA, one stroke) and in 7.4% at long-term FU (nine TIA, eight stroke). The total cerebrovascular event rate (TIA and CVA) was 0.02% per patientyear of FU, with a stroke rate of 0.01%. Conclusion:The Occlutech device appears to be safe at long-term FU with a very low annual cerebrovascular event rate and a low moderate to large shunt rate at 1-year FU. K E Y W O R D Spatent foramen ovale, percutaneous closure, stroke, transient ischemic attack

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“…All patients underwent contrast transcranial Doppler at FU. There was a residual RLS in 29% at 1 year and 17% at 5-years FU 17. These results are comparable to our findings.…”

supporting

confidence: 92%

Percutaneous patent foramen ovale closure using the Occlutech Figulla device: More than 1,300 patient‐years of follow up

Snijder

Renes

Suttorp

et al. 2018

Cathet Cardio Intervent

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“…In a study by Cheli et al, a right‐to‐left shunt was still detectable on transcranial Doppler 4.9 ± 2.3 years after the procedure in 55 patients; 20 (17%) had residual shunt and 35 (29%) had recurrent shunt. Neurological recurrences (13%) were equally distributed between the groups . In a study by Mirzaali et al, 301 patients underwent percutaneous PFO closure with 1 of 8 devices, with successful implantation in 99% of cases.…”

Section: Discussionmentioning

confidence: 98%

Long‐Term Contrast Echocardiography and Clinical Follow‐Up after Percutaneous Closure of Patent Foramen Ovale Using Two Different Atrial Septal Occluder Devices

Scalise¹,

Auguadro²,

Sorropago³

et al. 2016

J Interven Cardiology

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Percutaneous PFO closure was associated with a remarkably low risk of recurrent embolic neurological events, and no long-term device-related major complications. No statistically significant difference emerged between the 2 different SODs regarding BTTE positivity. Long-term follow-up showed that the recurrence of neurological events has been significantly higher in the group treated in a conservative way.

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“…Although small residual shunts were found in some patients during the occluder release, the position of the shunt was in the junction of the occluder and the deficient rim or in the occluder itself, and they did not need further medical treatment except for close observation. During the follow-up, the shunt wound became trivial or disappeared, due to the formation of endothelialization and the neointima fully closing, covering any residual shunting [ 30 , 31 ]. In our opinion, as long as the location of the occluder was firm and the left to right shunt decreased significantly, a small residual shunt can be ignored, and the corresponding clinical results were still good for the patients.…”

Section: Discussionmentioning

confidence: 99%

Midterm follow-up of transthoracic device closure of an atrial septal defect using the very large domestic occluder (44–48 mm), a single Chinese cardiac center experience

Chen

Cao

Zhang

et al. 2017

J Cardiothorac Surg

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BackgroundThe purpose of this study was to outline the midterm follow-up results and complications in patients who underwent transthoracic device closure of an atrial septal defect (ASD) with the very large domestic occluder (44–48 mm).MethodsThe data of 35 patients who underwent transthoracic device closure of an ASD with the very large domestic occluder (44–48 mm) at our institution were collected prospectively between January 2010 and January 2015. All patients were invited for an outpatient visit and contrast TTE for 12–70 months after ASD closure.ResultsThirty-four patients were occluded successfully under this approach and 1 patient was transferred for surgical repair for dislodgement of the occluder. The most frequent complication was transient cardiac arrhythmia. A new third degree atrioventricular block occurred in 1 patient who recovered 1 week later. During the follow-up period, we found no recurrence, no thrombosis, no device embolization, no device failure, and no cases of death. The total occlusion rate was 94.1% in the 12 months of follow-up, and the intracardiac structure and cardiac function were significant improved contemporaneously.ConclusionTransthoracic device closure of an atrial septal defect with the very large domestic occluder (44–48 mm) is a safe and feasible technique. However, long-term follow-up is required to better assess the safety and feasibility of this method for the closure of very large ASDs in patients.

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Recurrent and Residual Shunts After Patent Foramen Ovale Closure: Results From a Long‐Term Transcranial Doppler Study

Cited by 18 publications

References 38 publications

Percutaneous patent foramen ovale closure using the Occlutech Figulla device: More than 1,300 patient‐years of follow up

Percutaneous patent foramen ovale closure using the Occlutech Figulla device: More than 1,300 patient‐years of follow up

Long‐Term Contrast Echocardiography and Clinical Follow‐Up after Percutaneous Closure of Patent Foramen Ovale Using Two Different Atrial Septal Occluder Devices

Midterm follow-up of transthoracic device closure of an atrial septal defect using the very large domestic occluder (44–48 mm), a single Chinese cardiac center experience

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