title: Long-term results after fluoroscopy-guided closure of patent foramen ovale for secondary prevention of paradoxical embolism.
abstract: OBJECTIVE
  To carry out long-term follow-up after percutaneous closure of patent foramen ovale (PFO) in patients with cryptogenic stroke.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Single tertiary care centre.
  
  
  METHODS
  525 consecutive patients (mean (SD) age 51 (12) years; 56% male).
  
  
  METHODS
  Percutaneous PFO closure without intraprocedural echocardiography.
  
  
  METHODS
  Freedom from recurrent embolic events.
  
  
  RESULTS
  A mean (SD) of 1.7 (1.0) clinically apparent embolic events occurred for each patient, and 186 patients (35%) had >1 event. An atrial septal aneurysm was associated with the PFO in 161 patients (31%). All patients were followed up prospectively for up to 11 years. The implantation procedure failed in two patients (0.4%). There were 13 procedural complications (2.5%) without any long-term sequelae. Contrast transoesophageal echocardiography at 6 months showed complete closure in 86% of patients, and a minimal, moderate or large residual shunt in 9%, 3% and 2%, respectively. Patients with small occluders (<30 mm; n = 429) had fewer residual shunts (small 11% vs large 27%; p<0.001). During a mean (SD) follow-up of 2.9 (2.2) years (median 2.3 years; total 1534 patient-years), six ischaemic strokes, nine transient ischaemic attacks (TIAs) and two peripheral emboli occurred. Freedom from recurrent stroke, TIA, or peripheral embolism was 98% at 1 year, 97% at 2 years and 96% at 5 and 10 years, respectively. A residual shunt (hazard ratio = 3.4; 95% CI 1.3 to 9.2) was a risk factor for recurrence.
  
  
  CONCLUSIONS
  This study attests to the long-term safety and efficacy of percutaneous PFO closure guided by fluoroscopy only for secondary prevention of paradoxical embolism in a large cohort of consecutive patients.
authors.affiliation: Cardiology Department, University Hospital Bern, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Wahl
authors.forename: M
authors.initials: M
authors.lastname: Kunz
authors.forename: A
authors.initials: A
authors.lastname: Moschovitis
authors.forename: T
authors.initials: T
authors.lastname: Nageh
authors.forename: M
authors.initials: M
authors.lastname: Schwerzmann
authors.forename: C
authors.initials: C
authors.lastname: Seiler
authors.forename: H P
authors.initials: HP
authors.lastname: Mattle
authors.forename: S
authors.initials: S
authors.lastname: Windecker
authors.forename: B
authors.initials: B
authors.lastname: Meier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017548:Echocardiography, Transesophageal; D019320:Embolism, Paradoxical / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D004812:Epidemiologic Methods; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D054092:Foramen Ovale, Patent / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome