Percutaneous transcatheter closure of high-risk patent foramen ovale in the elderly

• Published in: Heart and vessels 2019-10, Vol.34 (10), p.1657-1662
• Main Authors: Takafuji, Hiroya, Hosokawa, Shinobu, Ogura, Riyo, Hiasa, Yoshikazu
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anesthesia; Aneurysms; Atrial Fibrillation - etiology; Biomedical Engineering and Bioengineering; Cardiac Catheterization; Cardiac Surgery; Cardiology; Complications; Echocardiography; Echocardiography, Transesophageal; Embolism; Embolism, Paradoxical - complications; Embolism, Paradoxical - therapy; Female; Fibrillation; Foramen Ovale, Patent - complications; Foramen Ovale, Patent - diagnostic imaging; Foramen Ovale, Patent - therapy; Geriatrics; Hemorrhage; Humans; Japan; Male; Medicine; Medicine & Public Health; Middle Aged; Morphology; Older people; Original; Original Article; Patients; Recurrence; Retrospective Studies; Risk; Septal Occluder Device - adverse effects; Time Factors; Treatment Outcome; Vascular Surgery
• ISSN: 0910-8327; 1615-2573
• DOI: 10.1007/s00380-019-01379-0

The efficacy of percutaneous transcatheter closure for preventing recurrent cerebrovascular events in elderly patients with high-risk patent foramen ovale (PFO) remains unclear, whereas in young patients, it has been shown to effectively prevent the recurrence of embolic stroke. The aim of this study was to investigate the safety and efficacy of percutaneous PFO closure in elderly patients with high-risk PFO. Between September 2012 and October 2018, 14 patients ≥ 60 years old with high-risk PFO underwent percutaneous closure to prevent recurrence of cerebrovascular events. The primary end point was recurrence of cerebrovascular events after closure in elderly patients with high-risk PFO, and the secondary end points were occurrence of device-related complications, cerebral hemorrhage, and new-onset atrial fibrillation (AF). The mean patient age and number of cerebrovascular events before closure were 75.2 ± 6.5 years and 1.7 ± 0.7, respectively. All procedures were successfully performed under general anesthesia by transesophageal echocardiography and using a 25-mm Amplatzer Cribriform device. No procedure-related complications occurred. Patients were followed up for a mean 2.6 ± 1.8 years. No patients experienced device-related complications or recurrent cerebrovascular events. However, one patient had AF-related device closure complications at 1 month postoperatively. In addition, other patient had a cerebral hemorrhage with unknown relationship to PFO closure 3 years postoperatively. Percutaneous closure of high-risk PFO in elderly patients may be as effective and safe as in younger patients. It is crucial to evaluate PFO morphology regardless of age in cases of paradoxical embolism.