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Damluji AA, Nanna MG, Rymer J, Kochar A, Lowenstern A, Baron SJ, Narins CR, Alkhouli M. Chronological vs Biological Age in Interventional Cardiology: A Comprehensive Approach to Care for Older Adults: JACC Family Series. JACC Cardiovasc Interv 2024; 17:961-978. [PMID: 38597844 PMCID: PMC11097960 DOI: 10.1016/j.jcin.2024.01.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 04/11/2024]
Abstract
Aging is the gradual decline in physical and physiological functioning leading to increased susceptibility to stressors and chronic illnesses, including cardiovascular disease. With an aging global population, in which 1 in 6 individuals will be older than 60 years by 2030, interventional cardiologists are increasingly involved in providing complex care for older individuals. Although procedural aspects remain their main clinical focus, interventionalists frequently encounter age-associated risks that influence eligibility for invasive care, decision making during the intervention, procedural adverse events, and long-term management decisions. The unprecedented growth in transcatheter interventions, especially for structural heart diseases at extremes of age, have pushed age-related risks and implications for cardiovascular care to the forefront. In this JACC state-of-the-art review, the authors provide a comprehensive overview of the aging process as it relates to cardiovascular interventions, with special emphasis on the difference between chronological and biological aging. The authors also address key considerations to improve health outcomes for older patients during and after their invasive cardiovascular care. The role of "gerotherapeutics" in interventional cardiology, technological innovation in measuring biological aging, and the integration of patient-centered outcomes in the older adult population are also discussed.
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Affiliation(s)
- Abdulla A Damluji
- Inova Center of Outcomes Research, Fairfax, Virginia, USA; Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael G Nanna
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jennifer Rymer
- Duke University School of Medicine, Durham, North Carolina USA
| | - Ajar Kochar
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Reibel I, Hauguel-Moreau M, Guedeney P, Hage G, Hammoudi N, Duthoit G, Zeitouni M, Lattuca B, Kernéis M, Collet JP, Silvain J, Montalescot G. Comparison of three echo-guidance techniques in percutaneous patent foramen ovale closure for stroke prevention: Conventional transoesophageal, microprobe transoesophageal and intracardiac echocardiography. Arch Cardiovasc Dis 2023; 116:523-528. [PMID: 37838576 DOI: 10.1016/j.acvd.2023.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Recent randomized trials have demonstrated a consistent reduction in recurrent stroke after percutaneous transcatheter patent foramen ovale closure versus medical therapy in patients with recent cryptogenic stroke. AIM To compare the safety and efficacy of intracardiac echocardiography-guided and microprobe transoesophageal echocardiography-guided patent foramen ovale closure under local anaesthesia with transoesophageal echocardiography-guided patent foramen ovale closure under general anaesthesia. METHODS This prospective observational single-centre study included 194 consecutive patients scheduled for patent foramen ovale closure for secondary prevention of stroke from February 2018 to December 2019. Patients were asked to choose between an intracardiac echocardiography-guided, microprobe transoesophageal echocardiography-guided or transoesophageal echocardiography-guided procedure. The primary endpoint was the rate of successful closure at 6 months, defined as correct positioning of the device without severe shunt on 6-month contrast echocardiography. RESULTS Successful closure was high and did not differ between groups: 97.8% (95% confidence interval 88.5-99.9%) in the intracardiac echocardiography-guided group versus 96.9% (95% confidence interval 83.8-99.9%) in the microprobe transoesophageal echocardiography-guided group and 99.1% (95% confidence interval 95.3-99.9%) in the transoesophageal echocardiography-guided group (P=0.63). Adverse events related to patent foramen ovale closure were low and did not differ between groups. CONCLUSION Our preliminary real-world experience suggests good efficacy and safety with intracardiac echocardiography and microprobe transoesophageal echocardiography guidance compared with conventional transoesophageal echocardiography guidance for percutaneous transcatheter patent foramen ovale closure in recurrent stroke prevention.
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Affiliation(s)
- Iphigénie Reibel
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Marie Hauguel-Moreau
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Paul Guedeney
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Georges Hage
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Nadjib Hammoudi
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Guillaume Duthoit
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Michel Zeitouni
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Benoit Lattuca
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Mathieu Kernéis
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Jean-Philippe Collet
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Johanne Silvain
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Gilles Montalescot
- Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
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Song JK. Pearls and Pitfalls in the Transesophageal Echocardiographic Diagnosis of Patent Foramen Ovale. J Am Soc Echocardiogr 2023; 36:895-905.e3. [PMID: 37196905 DOI: 10.1016/j.echo.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/19/2023]
Abstract
Large randomized controlled trials have shown the benefits of percutaneous closure of patent foramen ovale (PFO) in patients with cryptogenic stroke and PFO. Recent studies have highlighted the clinical significance and prognostic implication of various anatomical features of PFO and the adjacent atrial septum, such as atrial septal aneurysm (ASA), PFO size, large shunt, and hypermobility. Transthoracic echocardiography with contrast study is used for the indirect diagnosis of PFO, as it reveals the passage of the contrast into the left atrium. In contrast, transesophageal echocardiography (TEE) offers a direct demonstration of PFO by measuring its size using the maximum separation distance between the septum primum and septum secundum. Furthermore, TEE enables the acquisition of detailed anatomical features of the adjacent atrial septum including ASA, hypermobility, and PFO tunnel length, which carry significant prognostic implications. Transesophageal echocardiography also facilitates the diagnosis of pulmonary arteriovenous malformation, a relatively rare cause of paradoxical embolism. This review provides evidence for supporting TEE as a useful screening test for patients with cryptogenic stroke to identify suitable candidates for percutaneous device closure of PFO. Additionally, cardiac imaging specialists with proficiency in comprehensive TEE examination should be part of the heart-brain team for proper evaluation of and decision-making in patients with cryptogenic stroke.
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Affiliation(s)
- Jae-Kwan Song
- Professor of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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Alkhouli M, Van Houten HK, Yao X, Holmes DR. Effectiveness of Transcatheter Closure of Patent Foramen Ovale in Clinical Practice. J Am Heart Assoc 2023; 12:e030321. [PMID: 37489748 PMCID: PMC10492997 DOI: 10.1161/jaha.123.030321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/28/2023] [Indexed: 07/26/2023]
Abstract
Background Transcatheter closure of patent foramen ovale (PFO) has reduced the risk of recurrent stroke in patients with cryptogenic strokes in randomized clinical trials. Whether PFO closure in clinical practice is associated with similar benefit remains unknown. Methods and Results We identified patients with PFO and a history of ischemic stroke or transient ischemic attack who were treated with PFO closure or medical therapy in the OptumLabs database. The primary end point was recurrent ischemic stroke or systemic embolization. Secondary outcomes included mortality, all stroke, transient ischemic attack, and major bleeding. A total of 6668 propensity-matched patients were included (PFO closure n=4111; medical therapy n=2557). The incidence of stroke or systemic embolization per 100 person-years was 2.38 after PFO cohort and 2.99 with medical therapy (hazard ratio [HR], 0.85 [95% CI, 0.68-1.05], P=0.13). Mortality was lower in the PFO closure cohort (1.78 versus 2.59 per 100 person-years: HR, 0.69 [95% CI, 0.55-0.87], P=0.002). Falsification end points showed that this difference is unlikely to be completely explained by residual confounders. There were no significant differences between the groups in secondary end points including intracranial hemorrhage and major bleeding except for an increase in nonintracranial hemorrhage bleeding among patients treated with oral anticoagulation (1.42 versus 2.16 per 100 person-years: HR, 0.69 [95% CI, 0.48-0.99], P=0.043). The main end point was consistent in subanalyses including patients <60 years of age, patients with prior stroke, and those treated after the publication of the positive PFO trials in 2017. Conclusions In contemporary US practice, PFO closure is not associated with lower rates of recurrent ischemic stroke or systemic embolization compared with medical therapy. Potential reasons for this discrepancy warrant further investigation.
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Affiliation(s)
| | - Holly K. Van Houten
- Robert D. and Patricia E. Kern Center for the Science of Health Care DeliveryMayo ClinicRochesterMNUSA
- OptumLabsEden PrairieMNUSA
| | - Xiaoxi Yao
- Department of Cardiovascular MedicineMayo ClinicRochesterMNUSA
- OptumLabsEden PrairieMNUSA
| | - David R. Holmes
- Department of Cardiovascular MedicineMayo ClinicRochesterMNUSA
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Liu TT, Jiao RH, Chen T, Jiang ZA, Bai WL. A Systematic Review and Meta-Analysis of the Association between Residual Shunts after Patent Foramen Ovale Closure and Long-Term Cerebrovascular Events. Cerebrovasc Dis 2023; 52:387-392. [PMID: 36882039 DOI: 10.1159/000527457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 09/28/2022] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND The association between a patent foramen ovale (PFO) and cryptogenic stroke (CS) is well established, and the benefits of PFO closure are clearly recognized. This study aimed to investigate the presence of a residual shunt in patients who have experienced cryptogenic cerebrovascular events following a PFO closure. METHODS Two researchers systematically searched the PubMed and Embase online database for pertinent clinical studies published between January 2000 and July 2021 concerning the recurrence of cerebrovascular events after PFO closures. RESULTS Upon screening an initial list of 2,342 articles, six studies were identified, involving 2,083 patients. Overall, the analysis indicated a marked difference in the recurrence of cerebrovascular events in 8.89% of residual shunt (RS) cases compared to only 2.90% of non-RS cases. The summary odds ratio was 3.484 (95% confidence interval, 2.169-5.596), which suggested that RS may be a risk factor for recurrent cerebrovascular events in patients that experienced PFO-related cerebrovascular events within 6 months after PFO closure surgery. CONCLUSIONS The presence of RS significantly increases the risk of recurrent cerebrovascular events in patients with clinical PFO closure.
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Affiliation(s)
- Ting-Ting Liu
- Department of Heart Center, Hebei General Hospital, Shijiazhuang, China
| | - Rong-Hong Jiao
- Department of Ultrasound, Hebei General Hospital, Shijiazhuang, China
| | - Tao Chen
- Department of Cardiology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhi-An Jiang
- Department of Cardiology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wen-Lou Bai
- Department of Heart Center, Hebei General Hospital, Shijiazhuang, China
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Fakhra S, Sattar Y, Patel NN, Aziz S, Titus A, Almas T, Aamir M, Sulaiman S, Mishra NK, Elgendy IY, Raina S, Jagadeesan V, Daggubati R, Alraies MC. Comparison of Sex Based In-Hospital Procedural Outcomes and Hospital Readmission Frequency After Patent Foramen Ovale Occluder Device Placement: A Propensity Matched National Cohort. Curr Probl Cardiol 2023; 48:101662. [PMID: 36868331 DOI: 10.1016/j.cpcardiol.2023.101662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/17/2023] [Indexed: 03/05/2023]
Abstract
INTRODUCTION PFO occluder device has been shown to reduce the chance of recurrent stroke in clinically indication per guidelines, stroke is higher in females but procedural efficacy and complications based on sex difference is not well studied in literature. METHODS The Nationwide Readmission Database (NRD) was used to create sex cohorts using ICD-10 Procedural code for elective PFO occluder device placement performed during the years 2016-2019. The two groups were compared using propensity score matching (PSM) and multivariate regression models that matched for confounders to report multivariate odd's ratio (mOR) for primary and secondary cardiovascular outcomes. Outcomes included in-hospital mortality, acute kidney injury (AKI), acute ischemic stroke, post-procedure bleeding, and cardiac tamponade. Statistical analysis was performed using STATA v. 17. RESULTS A total of 5,818 patients who underwent PFO occluder device placement were identified, of which 3,144 (54.0%) were females, and 2,673 (46.0%) were males. There was no difference in periprocedural in-hospital mortality, new onset acute ischemic stroke, post-procedural bleeding, or cardiac tamponade between both sexes undergoing occluder device placement. AKI onset was higher in males as compared to females after matching for CKD (mOR = 0.66; 95% CI [0.48-0.92]; p=0.016) this can be procedural or can be secondary to volume status or nephrotoxins. Males also had a higher length of stay (LOS) at their index hospitalization (2 days vs 1 day) which led to slightly higher total hospitalization cost ($26,585 vs $24,265). Our data did not show a statistically significant difference in the readmission LOS trends between the two groups at 30, 90, and 180 days. CONCLUSION PFO occluder is equally efficacious in both sex and no significant difference in sex-based complications noticed on national cohort analysis. AKI occurrence was high in males that can be limited due to unavailability of data about hydration status and nephrotoxic medications.
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Affiliation(s)
- Sadaf Fakhra
- Department of Medicine, University of Nevada, Las Vegas-Kirk Kerkorian School of Medicine, USA
| | - Yasar Sattar
- Department of Cardiology and Structural Interventions, West Virginia University Heart and Vascular Institute, Morgantown, USA
| | - Neel N Patel
- Department of Medicine, New York Medical College/Landmark Medical Center, RI, USA
| | - Shazia Aziz
- Department of Internal Medicine, Carle Foundation Hospital, Urbana, IL, USA
| | - Anoop Titus
- Department of Medicine, Saint Vincent Hospital, Worcester, MA, USA
| | - Talal Almas
- Department of Internal Medicine, Mayo Clinic Ireland
| | - Muhammad Aamir
- Department of Cardiology, LeHigh Valley Hospital, Allentown, PA, USA
| | - Samian Sulaiman
- Department of Cardiology and Structural Interventions, West Virginia University Heart and Vascular Institute, Morgantown, USA
| | - Nishant K Mishra
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA
| | - Sameer Raina
- Department of Cardiology and Structural Interventions, West Virginia University Heart and Vascular Institute, Morgantown, USA
| | - Vikrant Jagadeesan
- Department of Cardiology and Structural Interventions, West Virginia University Heart and Vascular Institute, Morgantown, USA
| | - Ramesh Daggubati
- Department of Cardiology and Structural Interventions, West Virginia University Heart and Vascular Institute, Morgantown, USA
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Floria M, Năfureanu ED, Iov DE, Dranga M, Popa RF, Baroi LG, Sascău RA, Stătescu C, Tănase DM. Multimodality imaging approach of patent foramen ovale: Practical considerations for transient ischemic attack/stroke. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:1166-1176. [PMID: 36218207 DOI: 10.1002/jcu.23325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/31/2022] [Accepted: 08/03/2022] [Indexed: 06/16/2023]
Abstract
A patent foramen ovale, which is present in up to 25% of the population, is a risk factor for cryptogenic stroke (which accounts for 15%-40% of strokes) and transient ischemic attack via paradoxical embolism. This narrative review focuses on the multimodality imaging approach of the diagnosis and periprocedural guidance of patent foramen ovale, with an emphasis on the use of agitated saline as contrast medium in echocardiography, starting from embryologic aspects. Therefore, we aimed to make a concise and complete presentation of the protocol used for this type of evaluation, along with multimodality imaging approach of the patent foramen ovale and practical considerations for transient ischemic attack/stroke.
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Affiliation(s)
- Mariana Floria
- Internal Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy of Iași, Iaşi, Romania
- "Sf. Spiridon" Emergency Clinical Hospital, Iaşi, Romania
| | - Elena Diana Năfureanu
- Internal Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy of Iași, Iaşi, Romania
- Military Emergency Clinical Hospital, Iaşi, Romania
| | - Diana-Elena Iov
- Internal Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy of Iași, Iaşi, Romania
- "Sf. Spiridon" Emergency Clinical Hospital, Iaşi, Romania
| | - Mihaela Dranga
- Internal Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy of Iași, Iaşi, Romania
- "Sf. Spiridon" Emergency Clinical Hospital, Iaşi, Romania
| | - Radu Florin Popa
- "Sf. Spiridon" Emergency Clinical Hospital, Iaşi, Romania
- Surgery Department, "Grigore T. Popa" University of Medicine and Pharmacy of Iași, Iaşi, Romania
| | - Livia Genoveva Baroi
- "Sf. Spiridon" Emergency Clinical Hospital, Iaşi, Romania
- Surgery Department, "Grigore T. Popa" University of Medicine and Pharmacy of Iași, Iaşi, Romania
| | - Radu Andy Sascău
- Internal Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy of Iași, Iaşi, Romania
- Cardiovascular Disease Institute of Iaşi, Iaşi, Romania
| | - Cristian Stătescu
- Internal Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy of Iași, Iaşi, Romania
- Cardiovascular Disease Institute of Iaşi, Iaşi, Romania
| | - Daniela Maria Tănase
- Internal Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy of Iași, Iaşi, Romania
- "Sf. Spiridon" Emergency Clinical Hospital, Iaşi, Romania
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Gaetti G, Beneduce A, La Fauci D, Scardoni A, Chiappa F, Bellini L, Franzin M, Natale AM, Marras P, Ranieri P, Signorelli C, Bossi E, Ferrario L, Foglia E, Montorfano M, Odone A. Suture-Mediated Patent Foramen Ovale Closure Using the NobleStitch EL: Results from a Hospital-Based HTA. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137863. [PMID: 35805522 PMCID: PMC9266135 DOI: 10.3390/ijerph19137863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/18/2022] [Accepted: 06/24/2022] [Indexed: 11/17/2022]
Abstract
(1) Background: Patent foramen ovale (PFO) is a congenital abnormality present in up to 25% of the general population, and it is a relevant cause of cryptogenic stroke. We applied the hospital-based HTA model (AdHopHTA) to conduct a multidimensional assessment of NobleStitch EL, an innovative suture-mediated PFO closure device. We compared it to Amplatzer PFO Occluder (APO) to provide evidence to inform technologies’ governance in hospital settings. (2) Methods: For each AdHopHTA dimension we: systematically retrieved available evidence from the literature applying the PRISMA guidelines and then analyzed original clinical and cost data of a NobleStitch EL device at San Raffaele research hospital in Milan (Italy). The economic dimension was analyzed through activity-based costing and a cost analysis. We conducted semi-structured interviews with selected healthcare professionals to explore the organizational, legal, social, and ethical impact. (3) Results: A single study was included for the NobleStitch EL, with 10 for APO. Both literature data and original data showed comparable safety. Efficacy data analysis found that the PFO closure was at 89% for NobleStitch EL vs. 89–97% for APO. APO has a better impact on the budget and minor process costs. Consulted experts reported that the organizational impact of NobleStitch EL in the short and the long run as null, albeit a better impact under the social and the ethical aspects. (4) Conclusion: We suggest that there is inadequate evidence to conclude the relative efficacy of NobleStitch EL as compared to APO. Nevertheless, this report shows a good safety profile and higher costs for NobleStitch EL, with no organizational or legal impact. Further studies in selected population are recommended.
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Affiliation(s)
- Giovanni Gaetti
- School of Public Health, Vita-Salute San Raffaele University, 20132 Milan, Italy; (G.G.); (A.S.); (F.C.); (L.B.); (E.B.)
| | - Alessandro Beneduce
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (A.B.); (M.M.)
| | - Dario La Fauci
- HTA Committee, IRCCS San Raffaele Hospital, 20132 Milan, Italy; (D.L.F.); (M.F.); (A.M.N.); (P.M.); (P.R.); (C.S.)
| | - Alessandro Scardoni
- School of Public Health, Vita-Salute San Raffaele University, 20132 Milan, Italy; (G.G.); (A.S.); (F.C.); (L.B.); (E.B.)
| | - Federica Chiappa
- School of Public Health, Vita-Salute San Raffaele University, 20132 Milan, Italy; (G.G.); (A.S.); (F.C.); (L.B.); (E.B.)
| | - Lorenzo Bellini
- School of Public Health, Vita-Salute San Raffaele University, 20132 Milan, Italy; (G.G.); (A.S.); (F.C.); (L.B.); (E.B.)
| | - Michela Franzin
- HTA Committee, IRCCS San Raffaele Hospital, 20132 Milan, Italy; (D.L.F.); (M.F.); (A.M.N.); (P.M.); (P.R.); (C.S.)
| | - Anna Maria Natale
- HTA Committee, IRCCS San Raffaele Hospital, 20132 Milan, Italy; (D.L.F.); (M.F.); (A.M.N.); (P.M.); (P.R.); (C.S.)
| | - Paola Marras
- HTA Committee, IRCCS San Raffaele Hospital, 20132 Milan, Italy; (D.L.F.); (M.F.); (A.M.N.); (P.M.); (P.R.); (C.S.)
| | - Paolo Ranieri
- HTA Committee, IRCCS San Raffaele Hospital, 20132 Milan, Italy; (D.L.F.); (M.F.); (A.M.N.); (P.M.); (P.R.); (C.S.)
| | - Carlo Signorelli
- HTA Committee, IRCCS San Raffaele Hospital, 20132 Milan, Italy; (D.L.F.); (M.F.); (A.M.N.); (P.M.); (P.R.); (C.S.)
| | - Eleonora Bossi
- School of Public Health, Vita-Salute San Raffaele University, 20132 Milan, Italy; (G.G.); (A.S.); (F.C.); (L.B.); (E.B.)
| | - Lucrezia Ferrario
- Centre for Research on Health Economics, Social and Health Care Management, Carlo Cattaneo-LIUC University, 21053 Castellanza, Italy; (L.F.); (E.F.)
| | - Emanuela Foglia
- Centre for Research on Health Economics, Social and Health Care Management, Carlo Cattaneo-LIUC University, 21053 Castellanza, Italy; (L.F.); (E.F.)
| | - Matteo Montorfano
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (A.B.); (M.M.)
| | - Anna Odone
- HTA Committee, IRCCS San Raffaele Hospital, 20132 Milan, Italy; (D.L.F.); (M.F.); (A.M.N.); (P.M.); (P.R.); (C.S.)
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
- Correspondence:
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9
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Beneduce A, Ancona MB, Moroni F, Ancona F, Ingallina G, Melillo F, Russo F, Ferri LA, Bellini B, Vella C, Chieffo A, Agricola E, Montorfano M. A systematic transoesophageal echocardiography study of suture-mediated percutaneous patent foramen ovale closure. EUROINTERVENTION 2022; 18:63-67. [PMID: 34219660 PMCID: PMC9903155 DOI: 10.4244/eij-d-21-00242] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Alessandro Beneduce
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Bruno Ancona
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Moroni
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Ancona
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giacomo Ingallina
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Melillo
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Filippo Russo
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca A. Ferri
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Barbara Bellini
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ciro Vella
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eustachio Agricola
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
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10
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Hobbes B, Akseer S, Pikula A, Huszti E, Devereaux PJ, Horlick E, Abrahamyan L. Risk of Perioperative Stroke in Patients with Patent Foramen Ovale: A Systematic Review and Meta-Analysis. Can J Cardiol 2022; 38:1189-1200. [PMID: 35247468 DOI: 10.1016/j.cjca.2022.02.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Patent foramen ovale (PFO) is a common congenital cardiac abnormality. Risk of stroke increases perioperatively; however, the association of PFO with perioperative stroke risk remains unclear. We conducted a systematic review to inform the risk of perioperative stroke in patients with PFO undergoing surgery. METHODS EMBASE, MEDLINE, and Cochrane databases were searched from inception to January 2020. We described methods used for establishing PFO and perioperative stroke diagnosis. We conducted meta-analyses to obtain pooled estimates for risk of stroke in patients with and without PFO in different surgical populations. RESULTS Ten articles with a total of 20,858,011 patients met the eligibility criteria. Prevalence of PFO ranged from 0.06-1.4% based on ICD code diagnosis and 10.4-40.4% based on echocardiography diagnosis. Perioperative stroke was observed in 0-25% of patients with PFO, and 0-16.7% without PFO. Studies that use echocardiography to diagnose PFO found no association between PFO and perioperative stroke. Studies that used ICD codes, found strong association but were highly heterogenous. PFO was not associated with a risk of perioperative stroke in cardiac and transplant surgeries. While the adjusted odds ratios for stroke were substantial for orthopedic, general, genitourinary, neuro, and thoracic surgeries (with PFO status established based on ICD codes), data heterogeneity and quality of data create significant uncertainty. CONCLUSION In conclusion, PFO is likely a risk factor for perioperative stroke in select types of surgeries. However, this is based on a very low-quality evidence. Rigorous, prospective studies are needed to further investigate this relationship.
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Affiliation(s)
- Benjamin Hobbes
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Selai Akseer
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - Aleksandra Pikula
- Division of Neurology, Toronto Western Hospital, University Health Network (UHN), Toronto, ON, Canada
| | - Ella Huszti
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada; Biostatistics Research Unit, UHN, Toronto, Ontario, Canada
| | - P J Devereaux
- Population Health Research Institute, Hamilton, ON, Canada; Departments of Medicine, and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Eric Horlick
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre (PMCC), UHN, Toronto, Ontario, Canada
| | - Lusine Abrahamyan
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, UHN, Toronto, Ontario, Canada.
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11
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Alkhouli M, Moussa I, Deshmukh A, Ammash NM, Klaas JP, Holmes DR. The Heart Brain Team and Patient-Centered Management of Ischemic Stroke. JACC. ADVANCES 2022; 1:100014. [PMID: 38939078 PMCID: PMC11198076 DOI: 10.1016/j.jacadv.2022.100014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/28/2022] [Accepted: 02/28/2022] [Indexed: 06/29/2024]
Abstract
The multifaceted connections between the heart and the brain have been extensively studied at the anatomy, pathophysiology, and clinical levels. Studies have suggested a vital role for both cardiologists and neurologists in the management of various cardiovascular and neurological disorders. However, a true heart-brain team-based approach remained confined to large, specialized centers. In this paper, we review the various intersection areas of cardiology and neurology with regard to ischemic stroke. We focus our discussion on the challenges and opportunity for a heart-team approach to stroke in the context of atrial fibrillation, carotid disease, and patent foramen ovale, and in the setting of strokes complicating transcatheter endovascular interventions.
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Affiliation(s)
- Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Issam Moussa
- Carle Illinois College of Medicine, University of Illinois, Carle Heart and Vascular Institute, Champaign, Illinois, USA
| | - Abhishek Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Nasser M. Ammash
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - James P. Klaas
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - David R. Holmes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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12
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Mac Grory B, Ohman EM, Feng W, Xian Y, Yaghi S, Kamel H, Reznik ME. Advances in the management of cardioembolic stroke associated with patent foramen ovale. BMJ 2022; 376:e063161. [PMID: 35140114 DOI: 10.1136/bmj-2020-063161] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Patent foramen ovale (PFO) describes a valve in the interatrial septum that permits shunting of blood or thrombotic material between the atria. PFOs are present in approximately 25% of the healthy population and are not associated with any pathology in the vast majority of cases. However, comparisons between patients with stroke and healthy controls suggest that PFOs may be causative of stroke in certain patients whose stroke is otherwise cryptogenic. Options for the diagnosis of PFO include transthoracic echocardiography, transesophageal echocardiography, and transcranial Doppler ultrasonography. PFOs associated with an interatrial septal aneurysm seem to be more strongly linked to risk of recurrent stroke. Therapeutic options for secondary stroke prevention in the setting of a PFO include antiplatelet therapy, anticoagulation, and percutaneous device closure. Recent randomized clinical trials suggest that percutaneous closure reduces the subsequent risk of stroke in appropriately selected patients, with a large relative benefit but small absolute benefit. Referral for percutaneous PFO closure should therefore be considered in certain patients after a multidisciplinary, patient centered discussion. Areas for future study include structural biomarkers to aid in determining the role of PFO closure in older people with possible PFO associated stroke, the role of direct oral anticoagulants, and very long term outcomes after device closure.
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Affiliation(s)
- Brian Mac Grory
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - E Magnus Ohman
- Duke Clinical Research Institute, Durham, NC, USA
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Wuwei Feng
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Ying Xian
- Department of Neurology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Shadi Yaghi
- Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Hooman Kamel
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Michael E Reznik
- Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI, USA
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13
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Crea F. Emerging causes and risk factors of heart failure: amyloidosis, myocarditis, immune checkpoint inhibitors, air pollution, and visceral adipose tissue. Eur Heart J 2021; 42:1533-1537. [PMID: 33882575 DOI: 10.1093/eurheartj/ehab214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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14
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Romano V, Gallinoro CM, Mottola R, Serio A, Di Meglio F, Castaldo C, Sirico F, Nurzynska D. Patent Foramen Ovale-A Not So Innocuous Septal Atrial Defect in Adults. J Cardiovasc Dev Dis 2021; 8:jcdd8060060. [PMID: 34070460 PMCID: PMC8228640 DOI: 10.3390/jcdd8060060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/14/2021] [Accepted: 05/22/2021] [Indexed: 12/11/2022] Open
Abstract
Patent foramen ovale (PFO) is a common congenital atrial septal defect with an incidence of 15–35% in the adult population. The development of the interatrial septum is a process that begins in the fourth gestational week and is completed only after birth. During intrauterine life, the foramen ovale allows the passage of highly oxygenated blood from the right to the left atrium and into the systemic arteries, thus bypassing the pulmonary circulation. In 75% of the general population, the foramen ovale closes after birth, and only an oval depression, called fossa ovalis, remains on the right side of the interatrial septum. Patent foramen ovale can be associated with various clinically important conditions, including migraine and stroke, or decompression illness in divers. The aim of this review is to summarize the PFO developmental and anatomical features and to discuss the clinical risks associated with this atrial septal defect in adults.
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Affiliation(s)
- Veronica Romano
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (V.R.); (C.M.G.); (R.M.); (A.S.); (F.D.M.); (C.C.)
| | - Carlo Maria Gallinoro
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (V.R.); (C.M.G.); (R.M.); (A.S.); (F.D.M.); (C.C.)
| | - Rosita Mottola
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (V.R.); (C.M.G.); (R.M.); (A.S.); (F.D.M.); (C.C.)
| | - Alessandro Serio
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (V.R.); (C.M.G.); (R.M.); (A.S.); (F.D.M.); (C.C.)
| | - Franca Di Meglio
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (V.R.); (C.M.G.); (R.M.); (A.S.); (F.D.M.); (C.C.)
| | - Clotilde Castaldo
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (V.R.); (C.M.G.); (R.M.); (A.S.); (F.D.M.); (C.C.)
| | - Felice Sirico
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy; (V.R.); (C.M.G.); (R.M.); (A.S.); (F.D.M.); (C.C.)
- Correspondence: (F.S.); (D.N.)
| | - Daria Nurzynska
- Department of Medicine, Surgery and Dentistry “ScuolaMedicaSalernitana”, University of Salerno, 84081 Baronissi, Italy
- Correspondence: (F.S.); (D.N.)
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15
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Beneduce A, Moroni F, Montorfano M. Suture-Mediated Percutaneous Patent Foramen Ovale Closure: A Call for Careful Imaging Assessment. JACC Cardiovasc Interv 2021; 14:106-107. [PMID: 33413857 DOI: 10.1016/j.jcin.2020.10.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/27/2020] [Indexed: 11/17/2022]
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16
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How to do when PFO closure failed under routine guidance: the first clinical experience for PFO closure. J Geriatr Cardiol 2021; 18:89-90. [PMID: 33613663 PMCID: PMC7868909 DOI: 10.11909/j.issn.1671-5411.2021.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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17
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Abstract
Patent foram ovale (PFO) is the most common anatomical cause of an interarterial shunt. It is usually asymptomatic but may cause paradoxical embolism and is a risk factor for non-lacunar cryptogenic cerebral ischemia in young adults. Although the first clinical trials did not show a significant superiority of PFO closure in the secondary prevention of cerebral ischemia as compared with standard antithrombotic treatment, six subsequent randomized clinical trials (CLOSURE I, PC Trial, RESPECT, CLOSE, REDUCE, and DEFENSE-PFO) performed in a sample of cryptogenic stroke in patients aged 60 years or younger provided evidence of a significant reduction of recurrent cerebral ischemia after percutaneous PFO closure. However, the use of percutaneous PFO closure cannot be generalized to the entire population of patients with cerebral ischemia and PFO, but it is indicated in highly selected patients with non-lacunar cryptogenic cerebral infarction with a large right-to-left shunt, an atrial septal aneurysm and no evidence of atrial fibrillation, as well as in association with antithrombotic treatment for an optimal secondary prevention of cerebral ischemia.
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18
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Drakopoulou M, Soulaidopoulos S, Stathogiannis K, Oikonomou G, Papanikolaou A, Toutouzas K, Tousoulis D. Antiplatelet and Antithrombotic Therapy After Patent Foramen Oval and Atrial Septal Defect Closure. Curr Pharm Des 2021; 26:2769-2779. [PMID: 32338207 DOI: 10.2174/1385272824999200427083838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 05/18/2020] [Indexed: 12/18/2022]
Abstract
Pathologies of the atrial septum include different interatrial communications varying from patent foramen ovale (PFO) to actual defects. Atrial septal defects (ASDs) may be localized within the fossa ovalis such as the secundum type ASD or outside the region of fossa ovalis, such as the ostium primum defect and sinus venosus defect. Over the last decades, the percutaneous closure of interatrial shunts has become a feasible and safe method. During these procedures, the delicate balance between thrombotic risk, device sealing process and bleeding risk is crucial. In this review, we sought to describe current available data on the antiplatelet and antithrombotic management of patients after percutaneous ASD or PFO closure.
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Affiliation(s)
- Maria Drakopoulou
- First Department of Cardiology, Hippokration Hospital, Medical School of Athens University, Athens, Greece
| | - Stergios Soulaidopoulos
- First Department of Cardiology, Hippokration Hospital, Medical School of Athens University, Athens, Greece
| | - Konstantinos Stathogiannis
- First Department of Cardiology, Hippokration Hospital, Medical School of Athens University, Athens, Greece
| | - Georgios Oikonomou
- First Department of Cardiology, Hippokration Hospital, Medical School of Athens University, Athens, Greece
| | - Aggelos Papanikolaou
- First Department of Cardiology, Hippokration Hospital, Medical School of Athens University, Athens, Greece
| | - Konstantinos Toutouzas
- First Department of Cardiology, Hippokration Hospital, Medical School of Athens University, Athens, Greece
| | - Dimitrios Tousoulis
- First Department of Cardiology, Hippokration Hospital, Medical School of Athens University, Athens, Greece
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19
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Lüscher TF. The heart and the brain: cardiovascular risk factors, atrial fibrillation, and dementia. Eur Heart J 2020; 40:2271-2275. [PMID: 33215642 DOI: 10.1093/eurheartj/ehz508] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Thomas F Lüscher
- Imperial College and Director of Research, Education & Development, Royal Brompton and Harefield Hospitals London, UK.,Center for Molecular Cardiology, University of Zurich, Switzerland.,Editor-in-Chief, EHJ Editorial Office, Zurich Heart House, Hottingerstreet 14, Zurich, Switzerland
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20
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Lüscher TF. Frontiers in valvular heart disease: outcomes of novel percutaneous procedures. Eur Heart J 2020; 41:2717-2720. [PMID: 33216885 DOI: 10.1093/eurheartj/ehaa616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Thomas F Lüscher
- Professor of Cardiology, Imperial College and Director of Research, Education & Development, Royal Brompton and Harefield Hospitals London, UK.,Professor and Chairman, Center for Molecular Cardiology, University of Zurich, Switzerland.,Editor-in-Chief, EHJ Editorial Office, Zurich Heart House, Hottingerstreet 14, 8032 Zurich, Switzerland
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21
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Holmes DR, Alkhouli M. Past, Present, and Future of Interventional Cardiology. J Am Coll Cardiol 2020; 75:2738-2743. [PMID: 32466890 DOI: 10.1016/j.jacc.2020.03.066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 11/30/2022]
Affiliation(s)
- David R Holmes
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota. https://twitter.com/davidholmes2
| | - Mohamad Alkhouli
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
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22
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Tang PT, Cahill T, Rothwell PM, Ormerod OJ, Daniels MJ. Serial Shunt Evaluation Reveals Limitations of Contemporary Screening Studies for Patent Foramen Ovale. JACC Cardiovasc Interv 2020; 13:1269-1270. [PMID: 32438998 PMCID: PMC7254051 DOI: 10.1016/j.jcin.2020.01.210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/17/2019] [Accepted: 01/14/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | | | - Matthew J. Daniels
- Manchester University NHS Hospitals Trust, Division of Cardiovascular Sciences, Core Technology Facility 3.20, 46 Grafton Street, Manchester, Cheshire M13 9NT, United Kingdom @cardiacpolymath
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23
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Lüscher TF. TAVI is on the move! How it compares with surgery and what complications we still have to consider. Eur Heart J 2019; 40:3129-3133. [DOI: 10.1093/eurheartj/ehz733] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Thomas F Lüscher
- Professor of Cardiology, Imperial College and Director of Research, Education & Development, Royal Brompton and Harefield Hospitals London, UK
- Professor and Chairman, Center for Molecular Cardiology, University of Zurich, Switzerland
- Editor-in-Chief, EHJ Editorial Office, Zurich Heart House, Hottingerstreet 14, Zurich, Switzerland
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24
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Yang T, Butera G, Ou-Yang WB, Zhao GZ, Zhang FW, Pan XB. Percutaneous closure of patent foramen ovale under transthoracic echocardiography guidance-midterm results. J Thorac Dis 2019; 11:2297-2304. [PMID: 31372266 DOI: 10.21037/jtd.2019.06.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Conventional percutaneous closure of patent foramen ovale (PFO) is usually performed under the guidance of fluoroscopy. Whether closure of PFO under transthoracic echocardiography (TTE) guidance only is safe and effective is unknown. The present study therefore aimed to assess the safety and efficacy of percutaneous closure of PFO under TTE guidance only. Methods This study retrospectively enrolled a total of 52 consecutive patients (55.8% male, mean age 34.0±13.0 years, range, 10-59 years) with PFO treated at our institution from June 2015 to September 2017 by percutaneous closure under echocardiographic guidance only. The patients mean body weight was 58.7±10.8 kg. Patients underwent follow-up by TTE immediately post procedure by electrocardiogram and TTE at 1, 3, 6 and 12 months after discharge and annually thereafter, and by clinical evaluation at all time points. Results Of the 52 patients, 47 (90.4%) were successfully treated by percutaneous closure under TTE guidance. The mean procedure duration (from puncture to sheath removal) was 21.0±6.2 (range, 11-33) minutes. A trivial residual shunt which disappeared 24 hours later was observed in only 1 (1.9%) patient immediately post procedure. Median hospital stay was 3.0 days without severe complications such as peripheral vascular injury or cardiac perforation at discharge. At median 15.5 (11.3, 18.0) months follow-up, there were no complications such as death, stroke, transient ischemic attack (TIA) and residual shunt. Conclusions In this single center study of mostly lean patients, percutaneous closure of PFO under TTE guidance as the only imaging tool appeared effective at midterm follow-up, while avoiding radiation exposure, endotracheal intubation and contrast agent use.
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Affiliation(s)
- Tao Yang
- Department of Cardiovascular Surgery, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Disease, Beijing 100037, China
| | - Gianfranco Butera
- Department of Congenital Cardiology and Cardiac Surgery, IRCCS Policlinico San Donato-University Hospital, San Donato Milanese, Milan, Italy
| | - Wen-Bin Ou-Yang
- Department of Cardiovascular Surgery, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Disease, Beijing 100037, China
| | - Guang-Zhi Zhao
- Department of Cardiovascular Surgery, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Disease, Beijing 100037, China
| | - Feng-Wen Zhang
- Department of Cardiovascular Surgery, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Disease, Beijing 100037, China
| | - Xiang-Bin Pan
- Department of Cardiovascular Surgery, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Disease, Beijing 100037, China
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