PFO repair may increase stroke risk
MedWire News: Repair of incidentally discovered patent foramen ovale (PFO) during cardiothoracic surgery could increase the likelihood for postoperative stroke, US researchers report.
PFO is an opening in the upper chambers of the heart that fails to close naturally shortly after birth. “Epidemiological evidence is consistent with an increased risk for stroke associated with PFO but data are not conclusive,” explain Richard Karsuski and colleagues from the Cleveland Clinic in Ohio.
A recent survey suggested that cardiothoracic surgeons may alter planned procedures to repair incidentally discovered PFO, but how frequently this occurs and the impact on outcomes remain unknown, note the researchers.
To investigate, Karsuski and team reviewed the intra-operative transesophageal echocardiograms of 13,092 patients who underwent cardiothoracic surgery without prior diagnosis of PFO or atrial septal defect.
They found that intra-operative PFO was diagnosed in 2277 (17%) patients. Surgical closure was performed in 639 (28%) PFO patients, surgeons were significantly more likely to close defects in patients who were younger, were undergoing mitral or tricuspid valve surgery, or had history of transient ischemic attack or stroke.
Patients with intra-operatively diagnosed PFO had similar rates of in-hospital stroke and hospital death as those without PFO. However, patients who underwent PFO repair had a 2.5-fold increased risk for postoperative stroke compared with patients whose PFO was left unrepaired. In contrast, the numbers of hospital deaths were similar between the repaired and unrepaired PFO groups.
Long-term survival analysis demonstrated no difference between those with intra-operatively diagnosed PFO and those without. Furthermore, long-term mortality appeared similar between those undergoing repair and those whose PFO was left unrepaired.
“Incidental PFO is common in patients undergoing cardiothoracic surgery but is not associated with increased peri-operative morbidity or mortality,” observe Karsuski and co-authors in the Journal of the American Medical Association.
They conclude: “The finding that repair may increase postoperative stroke risk should discourage routine surgical closure and foster further investigation to delineate whether there is any benefit in terms of long-term stroke prevention and which patients might benefit from this intervention.”
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By Laura Dean