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Transcatheter PFO Closure With Short Aortic Rims
Quick Takes
- Aortic rim <9 mm was not a risk factor for device erosion in patients undergoing transcatheter patent foramen ovale (PFO) closure.
- Device erosion remains an extremely rare complication of atrial septal defect and PFO closure.
Study Questions:
What are the outcomes of transcatheter patent foramen ovale (PFO) closure in patients with short (<9 mm) aortic rims?
Methods:
A single-center retrospective study was performed of patients undergoing PFO with an Amplatzer PFO device between 2006 and 2017. Comparisons were made between patients with aortic rim <9 mm and those with larger aortic rims. Long-term outcomes were obtained by linkage to provincial administrative databases.
Results:
During the study period, 324 patients underwent PFO closure with the Amplatzer PFO device. The mean age was 49.8 years and 61% had a short aortic rim. The most common indication was cryptogenic stroke in 72% of patients. Patients with longer aortic distance were likely to have a nonstroke indication for closure, diabetes (15% vs. 6.5%, p = 0.04) and heart failure (15.7% vs. 4%, p < 0.01). Over a median of 7 years of follow-up, there were no cases of device erosion or embolization requiring cardiac surgery.
Conclusions:
The authors conclude that transcatheter PFO closure can be performed safely even in patients with short aortic rim.
Perspective:
Aortic erosion is a rare complication after closure of atrial level shunts. Short aortic rims have been implicated as a contributor to aortic erosion with atrial septal occluder device. This study assessed the safety of PFO occlusion with an Amplatzer PFO occluder in patients with aortic rim <9 mm. No erosions were seen in any of the 324 patients studied, including the 62% of patients with short aortic rims. The study supports safety of transcatheter PFO occlusion in patients with aortic rims <9 mm. The primary limitation of the study is the extremely low rate of device erosions (<1:1,000) in the setting of a total of 324 patients investigated.
Clinical Topics: Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Cardiac Surgery and CHD and Pediatrics, Cardiac Surgery and Heart Failure, Congenital Heart Disease, CHD and Pediatrics and Interventions, CHD and Pediatrics and Prevention, Acute Heart Failure, Interventions and Structural Heart Disease, Interventions and Vascular Medicine
Keywords: Cardiac Surgical Procedures, Coronary Occlusion, Diabetes Mellitus, Embolization, Therapeutic, Foramen Ovale, Patent, Heart Defects, Congenital, Heart Failure, Heart Septal Defects, Atrial, Ischemic Stroke, Septal Occluder Device, Stroke
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