title: Patent foramen ovale in liver transplant recipients does not negatively impact short-term outcomes.
abstract: OBJECTIVE
  Patent foramen ovale (PFO) is a common atrial septal defect that is largely asymptomatic and often undiagnosed. The impact of a PFO in patients undergoing liver transplantation (LT) is unknown.
  
  
  OBJECTIVE
  Assess the impact of PFO and physiologic intrapulmonary shunt (IPS) on the perioperative outcomes of patients who underwent LT.
  
  
  METHODS
  We performed a retrospective, intention-to-treat analysis of patients with PFO and controls without PFO who underwent LT at Mayo Clinic in Florida between 2008 and 2013. Patients with physiologic IPS were also analyzed. The cohorts were compared for baseline characteristics, length of stay in the intensive care unit (ICU), postoperative oxygen requirements, 30-d cerebrovascular accidents, and mortality.
  
  
  RESULTS
  Of the 935 patients who underwent LT, 10.4% had proven PFO by pre-LT echocardiogram. Control patients (n = 101) were statistically older than PFO and IPS (n = 56) patients, but similar in sex, BMI, Model for End-stage Liver Disease score, American Society of Anesthesiologist score, and left ventricular ejection fraction. PFO and IPS patients had similar length of stay in the ICU, mechanical ventilation times, post-LT oxygen requirements, and 30-d mortality compared to controls. Subgroup analysis showed similar outcomes for large PFO and IPS patients to controls.
  
  
  CONCLUSIONS
  The presence of PFO did not have a negative impact on perioperative LT outcomes.
authors.affiliation: Department of Internal Medicine, Mayo Clinic Florida, Jacksonville, FL, USA.
authors.forename: Monia E
authors.initials: ME
authors.lastname: Werlang
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, FL, USA.
authors.forename: William C
authors.initials: WC
authors.lastname: Palmer
authors.affiliation: CRISP Intern, Mayo Clinic, Jacksonville, FL, USA.
authors.forename: Evelyn A
authors.initials: EA
authors.lastname: Boyd
authors.affiliation: Department of Digestive and Liver Diseases, Gastroenterology, University of Texas Southwestern, Dallas, TX, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Cangemi
authors.affiliation: Division of Transplant Hepatology, Department of Transplantation, Mayo Clinic College of Medicine, Mayo Clinic Florida, Jacksonville, FL, USA.
authors.forename: Denise M
authors.initials: DM
authors.lastname: Harnois
authors.affiliation: Division of Transplant Hepatology, Department of Transplantation, Mayo Clinic College of Medicine, Mayo Clinic Florida, Jacksonville, FL, USA.
authors.forename: Cemal B
authors.initials: CB
authors.lastname: Taner
authors.affiliation: Department of Internal Medicine, Mayo Clinic Florida, Jacksonville, FL, USA.
authors.forename: Fernando F
authors.initials: FF
authors.lastname: Stancampiano
mesh_terms: D016022:Case-Control Studies; D058625:End Stage Liver Disease / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D054092:Foramen Ovale, Patent / Q000175:diagnosis / Q000503:physiopathology*; D006084:Graft Rejection / Q000503:physiopathology; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
keywords: intrapulmonary shunt; liver transplantation; mortality; patent foramen ovale; preoperative evaluation