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Voudris KV, Poulin MF, Kavinsky CJ. Updates on Patent Foramen Ovale (PFO) Closure. Curr Cardiol Rep 2024:10.1007/s11886-024-02073-y. [PMID: 38913234 DOI: 10.1007/s11886-024-02073-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 06/25/2024]
Abstract
PURPOSE OF REVIEW Patent foramen ovale (PFO) has been previously linked to left circulation thromboembolism and stroke. This review article aims to discuss the latest evidence, updated societal guidelines, diagnostic algorithms and novel therapeutic devices for PFO closure. RECENT FINDINGS PFO closure for cryptogenic stroke and systemic embolization is supported by a large body of evidence and has a strong societal recommendation. Limited data are available for platypnea-orthodeoxia syndrome, although closure appears to be beneficial. Current data do not support routine closure for migraines and decompression Illness. Development of heart-brain teams can improve identification of patients most likely to benefit from closure, utilizing a combination of imaging test and risk score algorithms. Multiple novel devices aiming at reducing complications and improving the long-term impact of current available devices are being evaluated. PFO closure has significantly progressed over the last years, with new data supporting its superiority in reducing risk of recurrent embolic stroke in patients with PFO-related stroke. Additional clinical data are required to provide further refinements on patient selection and guidance on treatment of specific subgroups.
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Affiliation(s)
- Konstantinos V Voudris
- Center for Valve and Structural Heart Disease, Minneapolis Heart Institute, Minneapolis, MN, USA
| | - Marie-France Poulin
- Department of Medicine, Cardiovascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Street, Baker 4, Boston, MA, 02215, USA
| | - Clifford J Kavinsky
- Department of Medicine, Cardiovascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Street, Baker 4, Boston, MA, 02215, USA.
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Eltelbany M, Gattani R, Ofosu-Somuah A, Damluji A, Epps KC, Batchelor WB. Transcatheter PFO closure for cryptogenic stroke: current approaches and future considerations. Front Cardiovasc Med 2024; 11:1391886. [PMID: 38832314 PMCID: PMC11144870 DOI: 10.3389/fcvm.2024.1391886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/15/2024] [Indexed: 06/05/2024] Open
Abstract
Patent Foramen Ovale (PFO) is a common congenital atrial septal defect present in 20%-35% of the general population. Although generally considered a benign anatomic variant, a PFO may facilitate passage of a thrombus from the venous to arterial circulation, thereby resulting in cryptogenic stroke or systemic embolization. A PFO is detected in nearly one half of patients presenting with cryptogenic stroke and often considered the most likely etiology when other causes have been excluded. In this review, we discuss the contemporary role of transcatheter closure of PFO in the treatment of cryptogenic stroke, including devices currently available for commercial use in the United States (Amplatzer PFOTM Occluder and GoreTM Cardioform Septal Occluder) and a novel suture-mediated device (NobleStitchTM EL) under clinical investigation. To provide the best care for cryptogenic stroke patients, practitioners should be familiar with the indications for PFO closure and corresponding treatment options.
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Affiliation(s)
- Moemen Eltelbany
- Inova Schar Heart and Vascular, Inova Fairfax Medical Campus, Falls Church, VA, United States
| | - Raghav Gattani
- Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA, United States
| | - Araba Ofosu-Somuah
- Division of Cardiology, Department of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Abdulla Damluji
- Inova Schar Heart and Vascular, Inova Fairfax Medical Campus, Falls Church, VA, United States
| | - Kelly C. Epps
- Inova Schar Heart and Vascular, Inova Fairfax Medical Campus, Falls Church, VA, United States
| | - Wayne B. Batchelor
- Inova Schar Heart and Vascular, Inova Fairfax Medical Campus, Falls Church, VA, United States
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Apostolos A, Tsiachris D, Drakopoulou M, Trantalis G, Oikonomou G, Ktenopoulos N, Simopoulou C, Katsaros O, Tsalamandris S, Aggeli C, Tsivgoulis G, Tsioufis C, Toutouzas K. Atrial Fibrillation After Patent Foramen Ovale Closure: Incidence, Pathophysiology, and Management. J Am Heart Assoc 2024; 13:e034249. [PMID: 38639354 PMCID: PMC11179870 DOI: 10.1161/jaha.124.034249] [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: 01/01/2024] [Accepted: 02/06/2024] [Indexed: 04/20/2024]
Abstract
This comprehensive review explores the incidence, pathophysiology, and management of atrial fibrillation (AF) following percutaneous closure of patent foramen ovale (PFO). Although AF is considered a common adverse event post PFO closure, its incidence, estimated at <5%, varies based on monitoring methods. The review delves into the challenging task of precisely estimating AF incidence, given subclinical AF and diverse diagnostic approaches. Notably, a temporal pattern emerges, with peak incidence around the 14th day after closure and a subsequent decline after the 45th day, mimicking general population AF trends. The pathophysiological mechanisms behind post PFO closure AF remain elusive, with proposed factors including local irritation, device-related interference, tissue stretch, and nickel hypersensitivity. Management considerations encompass rhythm control, with flecainide showing promise, and anticoagulation tailored to individual risk profiles. The authors advocate for a personalized approach, weighing factors like age, comorbidities, and device characteristics. Notably, postclosure AF is generally considered benign, often resolving spontaneously within 45 days, minimizing thromboembolic risks. Further studies are required to refine understanding and provide evidence-based guidelines.
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Affiliation(s)
- Anastasios Apostolos
- First Department of Cardiology, Medical SchoolNational and Kapodistrian University of Athens, Hippokration General HospitalAthensGreece
| | - Dimitrios Tsiachris
- First Department of Cardiology, Medical SchoolNational and Kapodistrian University of Athens, Hippokration General HospitalAthensGreece
| | - Maria Drakopoulou
- First Department of Cardiology, Medical SchoolNational and Kapodistrian University of Athens, Hippokration General HospitalAthensGreece
| | - Georgios Trantalis
- First Department of Cardiology, Medical SchoolNational and Kapodistrian University of Athens, Hippokration General HospitalAthensGreece
| | - Georgios Oikonomou
- First Department of Cardiology, Medical SchoolNational and Kapodistrian University of Athens, Hippokration General HospitalAthensGreece
| | - Nikolaos Ktenopoulos
- First Department of Cardiology, Medical SchoolNational and Kapodistrian University of Athens, Hippokration General HospitalAthensGreece
| | - Chrysavgi Simopoulou
- First Department of Cardiology, Medical SchoolNational and Kapodistrian University of Athens, Hippokration General HospitalAthensGreece
| | - Odysseas Katsaros
- First Department of Cardiology, Medical SchoolNational and Kapodistrian University of Athens, Hippokration General HospitalAthensGreece
| | - Sotirios Tsalamandris
- First Department of Cardiology, Medical SchoolNational and Kapodistrian University of Athens, Hippokration General HospitalAthensGreece
| | - Constantina Aggeli
- First Department of Cardiology, Medical SchoolNational and Kapodistrian University of Athens, Hippokration General HospitalAthensGreece
| | - Georgios Tsivgoulis
- Second Department of Neurology, Medical SchoolNational and Kapodistrian University of Athens, Attikon University Hospital of AthensAthensGreece
| | - Costas Tsioufis
- First Department of Cardiology, Medical SchoolNational and Kapodistrian University of Athens, Hippokration General HospitalAthensGreece
| | - Konstantinos Toutouzas
- First Department of Cardiology, Medical SchoolNational and Kapodistrian University of Athens, Hippokration General HospitalAthensGreece
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Cannata F, Stankowski K, Donia D, Figliozzi S, Fazzari F, Regazzoli D, Reimers B, Bragato RM, Pontone G, Trabattoni D, Colombo A, De Marco F, Mangieri A. Percutaneous suture-based patent foramen ovale closure: A state-of-the-art review. Trends Cardiovasc Med 2023:S1050-1738(23)00095-6. [PMID: 37931791 DOI: 10.1016/j.tcm.2023.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/18/2023] [Accepted: 10/31/2023] [Indexed: 11/08/2023]
Abstract
Percutaneous closure of a patent foramen ovale (PFO), a common variation of interatrial septum anatomy, is a commonly performed procedure in the catheterization laboratory to reduce the risk of recurrent stroke in selected patients and to treat other PFO-related syndromes. In the last twenty years, disc-based devices have represented the armamentarium of the interventional cardiologist; recently, suture-based devices have become an attractive alternative, despite limited data regarding their long-term performance. The present review gives an overview of the current evidence regarding suture-based PFO closure, the device's characteristics, the echocardiographic evaluation of the PFO anatomy, and recommendations for patient selection. A detailed procedural guide is then provided, and potential complications and future developments in the field are discussed.
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Affiliation(s)
- Francesco Cannata
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Milano, Italy; IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy; Department of Perioperative Cardiology and Cardiovascular imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy.
| | - Kamil Stankowski
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Milano, Italy; IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
| | - Dario Donia
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Milano, Italy; IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
| | - Stefano Figliozzi
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
| | - Fabio Fazzari
- Department of Perioperative Cardiology and Cardiovascular imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Damiano Regazzoli
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
| | - Bernhard Reimers
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
| | - Renato Maria Bragato
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Daniela Trabattoni
- Department of Interventional Cardiology, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, Milano, Italy; IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy
| | - Federico De Marco
- Department of Interventional Cardiology, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Antonio Mangieri
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy.
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Evola S, Camarda EA, Triolo OF, Adorno D, D’Agostino A, Novo G, Onorato EM. Clinical Outcomes and Quality of Life after Patent Foramen Ovale (PFO) Closure in Patients with Stroke/Transient Ischemic Attack of Undetermined Cause and Other PFO-Associated Clinical Conditions: A Single-Center Experience. J Clin Med 2023; 12:5788. [PMID: 37762729 PMCID: PMC10531865 DOI: 10.3390/jcm12185788] [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: 07/13/2023] [Revised: 08/24/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION The aim of this study was to assess clinical outcomes and quality of life after PFO closure in patients with previous stroke/TIA of undetermined cause and in patients with other complex PFO-associated clinical conditions. METHODS Between July 2009 and December 2019 at our University Cardiology Department, 118 consecutive patients underwent a thorough diagnostic work-up including standardized history taking, clinical evaluation, full neurological examination, screening for thrombophilia, brain magnetic resonance imaging (MRI), ultrasound-Doppler sonography of supra-aortic vessels and 24 h ECG Holter monitoring. Anatomo-morphological evaluation using 2D transthoracic/transesophageal echocardiography (TTE/TEE) color Doppler and functional assessment using contrast TTE (cTTE) in the apical four-chamber view and contrast transcranial Doppler (cTCD) using power M-mode modality were performed to verify the presence, location and amount of right-to-left shunting via PFO or other extracardiac source. Completed questionnaires based on the Quality-of-Life Short Form-36 (QoL SF-36) and Migraine Disability Assessment (MIDAS) were obtained from the patients before PFO closure and after 12 months. Contrast TTE/TEE and cTCD were performed at dismission, 1, 6 and 12 months and yearly thereafter. Brain MRI was performed at 1-year follow-up in 54 patients. RESULTS Transcatheter PFO closure was performed in 106 selected symptomatic patients (mean age 41.7 ± 10.7 years, range 16-63, 65% women) with the following conditions: ischemic stroke (n = 23), transient ischemic attack (n = 22), peripheral and coronary embolism (n = 2), MRI lesions without cerebrovascular clinical events (n = 53), platypnea-orthodeoxia (n = 1), decompression sickness (n = 1) and refractory migraine without ischemic cerebral lesions (n = 4). The implanted devices were Occlutech Figulla Flex I/II PFO (n = 99), Occlutech UNI (n = 3), Amplatzer PFO (n = 3) and CeraFlex PFO occluders (n = 1). Procedures were performed under local anesthesia and rotational intracardiac monitoring (Ultra ICE) alone. The devices were correctly implanted in all patients. The mean fluoroscopy time was 15 ± 5 min (range = 10-45 min) and the mean procedural time was 55 ± 20 min (range = 35-90 min). The total occlusion rate at follow-up (mean 50 months, range 3-100) was 98.1%. No recurrent neurological events were observed in the long-term follow-up. CONCLUSIONS The data collected in this study demonstrate that percutaneous PFO closure is a safe and effective procedure, showing long-term prevention of recurrent cerebrovascular events, significant reduction in migraine symptoms and substantial improvement in quality of life.
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Affiliation(s)
- Salvatore Evola
- Catheterization Laboratory, Department of Medicine and Cardiology, Azienda Ospedaliera Universitaria Policlinico “P. Giaccone”, Via del Vespro 129, 90127 Palermo, Italy; (S.E.); (E.A.C.); (O.F.T.); (D.A.); (A.D.)
| | - Emmanuele Antonio Camarda
- Catheterization Laboratory, Department of Medicine and Cardiology, Azienda Ospedaliera Universitaria Policlinico “P. Giaccone”, Via del Vespro 129, 90127 Palermo, Italy; (S.E.); (E.A.C.); (O.F.T.); (D.A.); (A.D.)
| | - Oreste Fabio Triolo
- Catheterization Laboratory, Department of Medicine and Cardiology, Azienda Ospedaliera Universitaria Policlinico “P. Giaccone”, Via del Vespro 129, 90127 Palermo, Italy; (S.E.); (E.A.C.); (O.F.T.); (D.A.); (A.D.)
| | - Daniele Adorno
- Catheterization Laboratory, Department of Medicine and Cardiology, Azienda Ospedaliera Universitaria Policlinico “P. Giaccone”, Via del Vespro 129, 90127 Palermo, Italy; (S.E.); (E.A.C.); (O.F.T.); (D.A.); (A.D.)
| | - Alessandro D’Agostino
- Catheterization Laboratory, Department of Medicine and Cardiology, Azienda Ospedaliera Universitaria Policlinico “P. Giaccone”, Via del Vespro 129, 90127 Palermo, Italy; (S.E.); (E.A.C.); (O.F.T.); (D.A.); (A.D.)
| | - Giuseppina Novo
- Department Promise, Università di Palermo, UOC Cardiologia, Azienda Ospedaliera Universitaria Policlinico “P. Giaccone”, Via del Vespro 129, 90127 Palermo, Italy;
| | - Eustaquio Maria Onorato
- University Cardiology Department, Galeazzi-Sant’Ambrogio Hospital, Scientific Institute for Research, Hospitalization and Healthcare (I.R.C.C.S.), Via Cristina Belgioioso 173, 20157 Milan, Italy
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Gaspardone A, Sgueglia GA, Gaspardone C, De Santis A, D'Ascoli E, Piccioni F, Iamele M, Giannico MB, Tarsia C, Versaci F. A new echocardiographic index to select patients for PFO suture-mediated percutaneous closure. Catheter Cardiovasc Interv 2023; 101:837-846. [PMID: 36841947 DOI: 10.1002/ccd.30604] [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: 05/06/2022] [Revised: 10/21/2022] [Accepted: 02/15/2023] [Indexed: 02/27/2023]
Abstract
OBJECTIVES To identify a simple echocardiographic predictor of procedural success to select patient for percutaneous suture-mediated patent fossa ovalis (PFO) closure. BACKGROUND Percutaneous suture-mediated PFO closure has been shown as a safe and advantageous alternative to device-based PFO closure, yet its overall success is slightly lower in unselected patients. METHODS Preprocedural transesophageal echocardiogram (TEE) of 302 patients (113 men, 45 ± 12 years) who underwent percutaneous suture-mediated PFO closure were reviewed. RESULTS At echocardiographic follow-up (3-6 months), residual right-to-left shunt (RLS) ≥2 was found in 60 (19.9%) patients. At multivariable analysis, only two anatomical variables measured at preprocedural TEE were found as independent predictors of residual RLS ≥ 2 at follow-up: PFO maximum width (odds ratio [OR] 1.89, 95% confidence interval [CI] 1.16-3.40, p = 0.02) and PFO minimal septa overlapping (OR 0.58, 95% CI 0.35-0.88, p = 0.02). An index based on the ratio of PFO maximum width to PFO minimum septal overlapping (W/SO) proved to be the most powerful predictor of RLS ≥ 2 at follow-up (OR 48.1, 95% CI 9.3-352.2, p < 0.01). The ROC curve for the W/SO ratio was found to have an AUC of 0.84 (95% CI 0.75-0.93) and a cut-off value of 0.61 yielding a sensitivity of 80% and specificity of 78% with a negative predictive value of 94%. A decision tree methodology's AUC was 0.75 (95% CI 0.67-0.83). CONCLUSIONS The results of this study indicate that the ratio between the maximum amplitude of the PFO and the minimum overlap of the septa is the best predictive index of a favorable result by using one stitch only.
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Affiliation(s)
| | | | - Carlo Gaspardone
- Cardiology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | | | | | | | - Maria Iamele
- U.O.C. di Cardiologia, Ospedale Sant'Eugenio, Rome, Italy
| | | | - Carmela Tarsia
- U.O.C. di Cardiologia, Ospedale Sant'Eugenio, Rome, Italy
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Onorato EM, Grancini L, Monizzi G, Mastrangelo A, Fabbiocchi F, Bartorelli AL. Noblestitch® system for PFO closure: A novel but judicious alternative to traditional devices—A case report. Front Cardiovasc Med 2023; 10:1095661. [PMID: 37063961 PMCID: PMC10097917 DOI: 10.3389/fcvm.2023.1095661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/13/2023] [Indexed: 04/03/2023] Open
Abstract
BackgroundPercutaneous suture-mediated patent foramen ovale (PFO) closure has recently been used with the aim of avoiding double-disc nitinol device implantation. This novel technique has been carried out successfully in several centers offering PFO closure with an effective closure rate comparable to conventional double-disc devices.Case summaryA 50-year-old man, a pentathlon athlete, suffering from a previous left-sided ischemic stroke, underwent percutaneous closure of a permanent right-to-left shunt via PFO with a large fenestrated septum primum aneurysm at another institution. The NobleStitch® system was successfully implanted using local anesthesia and under angiographic-fluoroscopic monitoring. He was discharged home on aspirin 100 mg daily with a moderate residual shunt on contrast transthoracic echocardiography (cTTE) that persisted unaltered at subsequent controls. After 7 months, unable to resume sporting activity because of physical discomfort and dyspnea on exertion, the patient asked for a second opinion at our Heart and Brain clinic. Two-dimensional (2D) TTE showed septum primum laceration next to a radiopaque polypropylene knot with a moderate bidirectional shunt located at the fenestrated septum primum far from the PFO site. A catheter-based closure of the septal defect was therefore planned under local anesthesia and rotational intracardiac echo monitoring. An equally sized discs 28.5 mm × 28.5 mm Flex II UNI occluder (Occlutech GmbH, Jena, Germany) was successfully implanted across the atrial septal defect without complications. The patient was discharged in good clinical conditions; dual antiplatelet therapy (aspirin 100 mg/daily and clopidogrel 75 mg/daily) was recommended for 2 months and then single antiplatelet therapy (aspirin100 mg/daily) up to 6 months. Abolition of the residual shunt was confirmed at 1- and 6-month follow-up by contrast transcranial Doppler and 2D color Doppler cTTE.DiscussionClosing a PFO with a suture-base system, without leaving a device implant behind, may be a cutting-edge technology and potential alternative to traditional devices. Nevertheless, meticulous selection of the PFO anatomies by 2D TEE is key to a successful closure procedure in order to avoid complications that must be managed again with a second percutaneous procedure or by surgery.
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Affiliation(s)
- Eustaquio Maria Onorato
- University Cardiology Department, Cardiologia Universitaria, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Luca Grancini
- University Cardiology Department, Cardiologia Universitaria, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Giovanni Monizzi
- University Cardiology Department, Cardiologia Universitaria, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Angelo Mastrangelo
- University Cardiology Department, Cardiologia Universitaria, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Franco Fabbiocchi
- University Cardiology Department, Cardiologia Universitaria, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Antonio L Bartorelli
- University Cardiology Department, Cardiologia Universitaria, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
- Department of Biomedical and Clinical Sciences, "Luigi Sacco", University of Milan, Milan, Italy
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Tarsia C, Gaspardone C, Sgueglia GA, DE Santis A, D'Ascoli E, Piccioni F, Iamele M, Posteraro GA, Cinque A, Gaspardone A. Atrial function analysis after percutaneous umbrella device and suture-mediated patent fossa ovalis closure. Minerva Cardiol Angiol 2023; 71:83-90. [PMID: 34713674 DOI: 10.23736/s2724-5683.21.05710-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Atrial fibrillation is an undesirable event following percutaneous patent fossa ovalis (PFO) closure with metallic occluders, suggesting that implanting a rigid closure device could alter atrial function. Suture-mediated PFO closure is a new technique, achieving closure of the PFO by means of a simple suture. Aim of this study was to evaluate left atrial function after closure of PFO by direct suture and traditional occluders. METHODS We studied 40 age and sex homogeneous patients, 20 undergoing PFO closure by device (OCL) and 20 by suturing (NS). Twenty healthy sex-age matched subjects made up the control group (CT). Left atrial function was evaluated by using volumetric and speckle-tracking analysis assessing the following parameters: total emptying fraction (EF), Expansion Index (EI), active emptying fraction (AEF), strain values of the reservoir (r-ED), conduit (cd-ED) and contraction phase (ct-ED). RESULTS Compared to CT and NS, OCL patients had significantly worst indices of left atrial reservoir function (EF P=0.001, EI P=0.003, r-ED P<0.001), conduit function (cd-ED P=0.018) and contraction function (AEF P=0.010; ct-ED P<0.001). No significant differences were observed in left atrial function indices between CT and NS patients. CONCLUSIONS Suture-mediated PFO closure does not alter left atrial function. Conversely, metallic occluder is associated with worse left atrium function. This detrimental effect on atrial function could favor the development of atrial arrhythmias.
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Affiliation(s)
| | | | | | | | | | | | - Maria Iamele
- Unit of Cardiology, Sant'Eugenio Hospital, Rome, Italy
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Stout PA, Tabrizi NS, Tribble M, Richvalsky T, Youn C, Md BW, Shapeton AD, Musuku SR. NobleStitch Patent Foramen Ovales Closure for Recurrent Strokes in a Patient with COVID-19 on Extracorporeal Membrane Oxygenation. J Cardiothorac Vasc Anesth 2023; 37:261-265. [PMID: 36372721 DOI: 10.1053/j.jvca.2022.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/27/2022] [Accepted: 10/13/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Perry A Stout
- Albany Medical College, Albany, NY; Department of Anesthesiology and Perioperative Medicine, Albany Medical Center, Albany, NY
| | | | - Matt Tribble
- Department of Anesthesiology and Perioperative Medicine, Albany Medical Center, Albany, NY
| | - Tanya Richvalsky
- Department of Anesthesiology and Perioperative Medicine, Albany Medical Center, Albany, NY
| | - Cindy Youn
- Department of Anesthesiology and Perioperative Medicine, Albany Medical Center, Albany, NY
| | - Brion Winston Md
- Department of Cardiology/Interventional Cardiology, (Capital Cardiology Associates), Albany Medical Center, Albany, NY
| | - Alexander D Shapeton
- Veterans Affairs Boston Healthcare System, Department of Anesthesia, Critical Care and Pain Medicine, and Tufts University School of Medicine, Boston, MA
| | - Sridhar R Musuku
- Department of Anesthesiology and Perioperative Medicine, Albany Medical Center, Albany, NY.
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Muacevic A, Adler JR, Satyadi M, Keita P, Nobles A, Misselbeck T, Kluck B. Traumatic Atrial Septal Defect Repair via Primary Endovascular Suture Method: Case Report and Operative Technique. Cureus 2023; 15:e33679. [PMID: 36788870 PMCID: PMC9918876 DOI: 10.7759/cureus.33679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
We report a case of a 20-year-old male with no prior medical history who was found to have an atrial septal defect on echocardiography following a motor vehicle accident (MVA). The patient underwent primary percutaneous defect closure using the NobleStitch EL (Heartstitch, Fountain Valley, California) cardiovascular suturing system with intra-operative Doppler echocardiogram showing no residual shunt or color flow. There were no operative complications. At five months follow-up, the patient reported no symptoms from the procedure. In the case of traumatic atrial septal defect repair, the NobleStitch EL system may be utilized as an alternative to open heart surgery.
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A new era in patent foramen ovale closure - a percutaneous suture-based 'deviceless' technique (NobleStitch®): Experience of a Portuguese center. Rev Port Cardiol 2023; 42:53-59. [PMID: 36116990 DOI: 10.1016/j.repc.2021.08.015] [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: 05/25/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION In patients with cryptogenic stroke, one of the most frequently found abnormalities is patent foramen ovale (PFO). Percutaneous 'deviceless' systems based on surgical suture-mediated PFO closure have recently been introduced and show a favorable efficacy and safety profile with clear advantages. OBJECTIVES To present procedural details of the technique and baseline characteristics of patients who underwent the procedure in our center. METHODS A single-center prospective observational registry was established between February 2020 and February 2021, to assess the safety, efficacy and possible advantages of a novel percutaneous PFO closure system (NobleStitch® EL). Patient and PFO characteristics as well as technical features were collected for analysis. RESULTS Twenty-three patients were considered suitable for this technique after transesophageal echocardiography. Their mean age was 51 years and 69.5% were women. Most patients (91.3%) had a history of cryptogenic stroke. PFO closure with the NobleStitch® system was successfully performed in all patients. All procedures were performed under local anesthesia and fluoroscopic monitoring. The mean duration of the procedure was 52 min and median contrast dose used was 187 ml. Median radiation dose absorbed per patient was 61.5 Gy cm2. All patients were discharged asymptomatic 24 hours after the procedure with no peri- or postprocedural complications recorded. CONCLUSION Suture-mediated PFO closure represents a valid and safe alternative to traditional umbrella-like devices, and is feasible in the majority of PFO anatomies. Follow-up information, results of larger series and clinical trials may possibly validate this technique as the first choice for PFO closure.
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12
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Rigatelli G, Zuin M, Rodinò G, Marchese G, Pasquetto G. Recent advances in catheter devices for patent foramen ovale closure. Expert Rev Med Devices 2023; 20:29-34. [PMID: 36656563 DOI: 10.1080/17434440.2023.2170782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Over the last 5 years, the armamentarium of the interventional cardiologist dealing with percutaneous closure of patent foramen ovale (PFO) has been enriched by some novel devices and further improvements of existing ones that have or promise to increase the safety and effective closure rate of PFO patients. AREAS COVERED This review presents and discusses recent advancements in device design and composition from both technical and clinical perspectives. EXPERT OPINION Device technology is continuously evolving. The recent modification of delivery system, device hooking, and composition, as well as the advent of new bioabsorbable materials, is promising to make percutaneous PFO closure devices safer. The search for more effectiveness with possibly less metal behind is still ongoing.
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Affiliation(s)
- Gianluca Rigatelli
- Interventional Cardiology Unit, Division of Cardiology, Ospedali Riuniti Padova Sud, Padova, Italy
| | - Marco Zuin
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Giulio Rodinò
- Interventional Cardiology Unit, Division of Cardiology, Ospedali Riuniti Padova Sud, Padova, Italy
| | - Giuseppe Marchese
- Interventional Cardiology Unit, Division of Cardiology, Ospedali Riuniti Padova Sud, Padova, Italy
| | - Giampaolo Pasquetto
- Interventional Cardiology Unit, Division of Cardiology, Ospedali Riuniti Padova Sud, Padova, Italy
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13
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Advances in Percutaneous Patent Foramen Ovale Closure: From the Procedure to the Echocardiographic Guidance. J Clin Med 2022; 11:jcm11144001. [PMID: 35887765 PMCID: PMC9319304 DOI: 10.3390/jcm11144001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/02/2022] [Accepted: 07/07/2022] [Indexed: 02/05/2023] Open
Abstract
Percutaneous patent foramen ovale (PFO) closure by traditional, double disc occluder devices was shown to be safe for patients with PFO, and more effective than prolonged medical therapy in preventing recurrent thromboembolic events. The novel suture-mediated “deviceless” PFO closure system overcomes most of the risks and limitations associated with the traditional PFO occluders, appearing to be feasible in most interatrial septum anatomies, even if data about its long-term effectiveness and safety are still lacking. The aim of the present review was to provide to the reader the state of the art about the traditional and newer techniques of PFO closure, focusing both on the procedural aspects and on the pivotal role of transesophageal echocardiography (TEE) in patient’s selection, peri-procedural guidance, and post-interventional follow-up.
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14
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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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15
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Clinical and brain magnetic resonance imaging long-term follow-up in patients with cryptogenic stroke undergoing PFO closure with the NobleStitch EL system. A single-centre experience. Adv Cardiol 2022; 18:167-169. [PMID: 36051829 PMCID: PMC9421508 DOI: 10.5114/aic.2022.118534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/03/2022] [Indexed: 11/20/2022]
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16
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Zannoni J, Popolo Rubbio A, Tusa MB, Corciu AI, Casenghi M, Cannone G, Barletta M, Stefanini E, Mantovani V, Gorla R, Brambilla N, Testa L, Bedogni F, De Marco F. Mechanisms of ineffective patent foramen ovale closure using the percutaneous suture-mediated NobleStitch system. EUROINTERVENTION 2022; 18:68-70. [PMID: 35403602 PMCID: PMC9903156 DOI: 10.4244/eij-d-21-01021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jessica Zannoni
- Clinical and Interventional Cardiology Department, IRCCS Policlinico San Donato, Piazza Edmondo Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Antonio Popolo Rubbio
- Clinical and Interventional Cardiology Department, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Maurizio B. Tusa
- Clinical and Interventional Cardiology Department, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Anca I. Corciu
- Clinical and Interventional Cardiology Department, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Matteo Casenghi
- Clinical and Interventional Cardiology Department, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Gaspare Cannone
- Clinical and Interventional Cardiology Department, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Marta Barletta
- Clinical and Interventional Cardiology Department, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Elisa Stefanini
- Clinical and Interventional Cardiology Department, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Valentina Mantovani
- Clinical and Interventional Cardiology Department, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Riccardo Gorla
- Clinical and Interventional Cardiology Department, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Nedy Brambilla
- Clinical and Interventional Cardiology Department, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Luca Testa
- Clinical and Interventional Cardiology Department, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Francesco Bedogni
- Clinical and Interventional Cardiology Department, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Federico De Marco
- Clinical and Interventional Cardiology Department, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
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17
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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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18
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Scoccia A, Ielasi A, Laricchia A, Barki M, Maliandi G, Tespili M, Giannini F, Colombo A, Mangieri A. Percutaneous suture-based closure of patent foramen ovale: Initial results of a multi-center experience in a highly selected population. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 43:147-149. [DOI: 10.1016/j.carrev.2022.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 03/30/2022] [Accepted: 03/30/2022] [Indexed: 11/03/2022]
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19
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Beyhoff N, Zhu M, Zanders L, Leistner DM, Nobles A, Schroeder M, Barbieri F, Landmesser U, Reinthaler M. Teleproctoring for Training in Structural Heart Interventions: Initial Real-World Experience During the COVID-19 Pandemic. J Am Heart Assoc 2022; 11:e023757. [PMID: 35132869 PMCID: PMC9245799 DOI: 10.1161/jaha.121.023757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Proctoring represents a cornerstone in the acquisition of state‐of‐the‐art cardiovascular interventions. Yet, travel restrictions and containment measures during the COVID‐19 pandemic limited on‐site proctoring for training and expert support in interventional cardiology. Methods and Results We established a teleproctoring setup for training in a novel patent foramen ovale closure device system (NobleStitch EL, HeartStitch Inc, Fountain Valley, CA) at our institution using web‐based real‐time bidirectional audiovisual communication. A total of 6 patients with prior paradoxical embolic stroke and a right‐to‐left shunt of grade 2 or 3 were treated under remote proctorship after 3 cases were performed successfully under on‐site proctorship. No major device/procedure‐related adverse events occurred, and none of the patients had a residual right‐to‐left shunt of grade 1 or higher after the procedure. Additionally, we sought to provide an overview of current evidence available for teleproctoring in interventional cardiology. Literature review was performed identifying 6 previous reports on teleproctoring for cardiovascular interventions, most of which were related to the current COVID‐19 pandemic. In all reports, teleproctoring was carried out in similar settings with comparable setups; no major adverse events were reported. Conclusions Teleproctoring may represent a feasible and safe tool for location‐independent and cost‐effective training in a novel patent foramen ovale closure device system. Future prospective trials comparing teleproctoring with traditional on‐site proctoring are warranted.
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Affiliation(s)
- Niklas Beyhoff
- Department of Cardiology, Campus Benjamin Franklin Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin Berlin Germany.,German Centre for Cardiovascular Research (DZHK), partner site Berlin Berlin Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin Berlin Germany
| | - Miry Zhu
- Department of Cardiology, Campus Benjamin Franklin Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin Berlin Germany
| | - Lukas Zanders
- Department of Cardiology, Campus Benjamin Franklin Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin Berlin Germany.,German Centre for Cardiovascular Research (DZHK), partner site Berlin Berlin Germany
| | - David M Leistner
- Department of Cardiology, Campus Benjamin Franklin Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin Berlin Germany.,German Centre for Cardiovascular Research (DZHK), partner site Berlin Berlin Germany
| | - Anthony Nobles
- School of Biomedical Engineering, Westsächsische Hochschule Zwickau Germany
| | - Mark Schroeder
- Institute of Biomaterial Science Helmholtz-Zentrum Geesthacht Teltow Germany
| | - Fabian Barbieri
- Department of Cardiology, Campus Benjamin Franklin Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin Berlin Germany
| | - Ulf Landmesser
- Department of Cardiology, Campus Benjamin Franklin Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin Berlin Germany.,German Centre for Cardiovascular Research (DZHK), partner site Berlin Berlin Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin Berlin Germany
| | - Markus Reinthaler
- Department of Cardiology, Campus Benjamin Franklin Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin Berlin Germany.,Institute of Biomaterial Science Helmholtz-Zentrum Geesthacht Teltow Germany
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20
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Kasner SE, Lattanzi S, Fonseca AC, Elgendy AY. Uncertainties and Controversies in the Management of Ischemic Stroke and Transient Ischemic Attack Patients With Patent Foramen Ovale. Stroke 2021; 52:e806-e819. [PMID: 34702068 DOI: 10.1161/strokeaha.121.034778] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Multiple randomized clinical trials have demonstrated the benefit of patent foramen ovale closure over medical therapy alone for patients who have had a stroke that has been attributed to the patent foramen ovale. Nevertheless, there are many areas of uncertainty and controversy related to patient selection, pathophysiology, diagnosis, and treatment. We summarize the available data on these challenging topics and attempt to provide some clarity and future directions for clinicians and investigators.
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Affiliation(s)
- Scott E Kasner
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (S.E.K.)
| | - Simona Lattanzi
- Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy (S.L.)
| | - Ana Catarina Fonseca
- Department of Neurology, Centro Hospitalar Universitário Lisboa Norte, Faculdade de Medicina, Universidade de Lisboa, Portugal (A.C.F.)
| | - Akram Y Elgendy
- Division of Cardiovascular Medicine, University of California San Francisco (A.Y.E.).,Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, OH (A.Y.E.)
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21
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Calabrò P, Gragnano F, Niccoli G, Marcucci R, Zimarino M, Spaccarotella C, Renda G, Patti G, Andò G, Moscarella E, Mancone M, Cesaro A, Giustino G, De Caterina R, Mehran R, Capodanno D, Valgimigli M, Windecker S, Dangas GD, Indolfi C, Angiolillo DJ. Antithrombotic Therapy in Patients Undergoing Transcatheter Interventions for Structural Heart Disease. Circulation 2021; 144:1323-1343. [PMID: 34662163 DOI: 10.1161/circulationaha.121.054305] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Contemporary evidence supports device-based transcatheter interventions for the management of patients with structural heart disease. These procedures, which include aortic valve implantation, mitral or tricuspid valve repair/implantation, left atrial appendage occlusion, and patent foramen ovale closure, profoundly differ with respect to clinical indications and procedural aspects. Yet, patients undergoing transcatheter cardiac interventions require antithrombotic therapy before, during, or after the procedure to prevent thromboembolic events. However, these therapies are associated with an increased risk of bleeding complications. To date, challenges and controversies exist regarding balancing the risk of thrombotic and bleeding complications in these patients such that the optimal antithrombotic regimens to adopt in each specific procedure is still unclear. In this review, we summarize current evidence on antithrombotic therapies for device-based transcatheter interventions targeting structural heart disease and emphasize the importance of a tailored approach in these patients.
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Affiliation(s)
- Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy (P.C., F.G., E.M., A.C.).,Division of Cardiology, A.O.R.N. "Sant'Anna e San Sebastiano," Caserta, Italy (P.C., F.G., E.M., A.C.)
| | - Felice Gragnano
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy (P.C., F.G., E.M., A.C.).,Division of Cardiology, A.O.R.N. "Sant'Anna e San Sebastiano," Caserta, Italy (P.C., F.G., E.M., A.C.)
| | - Giampaolo Niccoli
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (G.N.).,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy (G.N.).,Department of Medicine, University of Parma, Italy (G.N.)
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, Italy (R. Marcucci.)
| | - Marco Zimarino
- Institute of Cardiology, University "G. D'Annuzio" of Chieti-Pescara, Italy (M.Z., G.R)
| | - Carmen Spaccarotella
- Department of Medical and Surgical Sciences, Magna Grecia University, Catanzaro, Italy (C.S., C.I.)
| | - Giulia Renda
- Institute of Cardiology, University "G. D'Annuzio" of Chieti-Pescara, Italy (M.Z., G.R)
| | - Giuseppe Patti
- Department of Translational Medicine, "Maggiore della Carità" Hospital, University of Eastern Piedmont, Via Solaroli, Novara, Italy (G.P.)
| | - Giuseppe Andò
- Unit of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy (G.A.)
| | - Elisabetta Moscarella
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy (P.C., F.G., E.M., A.C.).,Division of Cardiology, A.O.R.N. "Sant'Anna e San Sebastiano," Caserta, Italy (P.C., F.G., E.M., A.C.)
| | - Massimo Mancone
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Italy (M.M.)
| | - Arturo Cesaro
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy (P.C., F.G., E.M., A.C.).,Division of Cardiology, A.O.R.N. "Sant'Anna e San Sebastiano," Caserta, Italy (P.C., F.G., E.M., A.C.)
| | - Gennaro Giustino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (G.G., R. Mehran., G.D.D.)
| | - Raffaele De Caterina
- University Cardiology Division, University of Pisa, Pisa University Hospital, Italy; Fondazione Villa Serena per la Ricerca, Città Sant'Angelo, Italy (R.D.C.)
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (G.G., R. Mehran., G.D.D.)
| | - Davide Capodanno
- Cardio-Thoracic-Vascular Department, Centro Alte Specialità e Trapianti, Catania, Italy (D.C.).,Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco," University of Catania, Italy (D.C.)
| | - Marco Valgimigli
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland (M.V.).,Department of Cardiology, Bern University Hospital, University of Bern, Switzerland (M.V., S.W.)
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, University of Bern, Switzerland (M.V., S.W.)
| | - George D Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (G.G., R. Mehran., G.D.D.)
| | - Ciro Indolfi
- Department of Medical and Surgical Sciences, Magna Grecia University, Catanzaro, Italy (C.S., C.I.).,Mediterranea Cardiocentro, Naples, Italy (C.I.)
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville (D.J.A.)
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22
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Gaspardone A, Sgueglia GA, De Santis A, D'Ascoli E, Iamele M, Piccioni F, Giannico B, D'Errico F, Gioffrè G, Summaria F, Gaspardone C, Versaci F. Predictors of Residual Right-to-Left Shunt After Percutaneous Suture-Mediated Patent Fossa Ovalis Closure. JACC Cardiovasc Interv 2021; 13:2112-2120. [PMID: 32972572 DOI: 10.1016/j.jcin.2020.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/27/2020] [Accepted: 06/02/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This study sought to assess patent fossa ovalis (PFO) anatomy by transesophageal echocardiography (TEE) in patients undergoing percutaneous suture-mediated PFO closure to identify predictors of post-procedural residual atrial right-to-left shunt (RLS). BACKGROUND Percutaneous suture-mediated PFO closure has been proven to be a safe and effective technique in most PFO patients. METHODS From June 2016 to October 2019, 247 consecutive patients underwent percutaneous suture-mediated PFO closure at our institution. Of them, 230 (46 ± 13 years of age, 146 women) had complete and technically evaluable pre-procedural TEE. The following parameters in short-axis view were assessed: presence and grade of spontaneous RLS, PFO length and width, presence of atrial septal aneurysm and its maximal bulge, and presence of an embryonic or fetal remnant (Chiari network or Eustachian valve). RESULTS At the first follow-up transthoracic echocardiography performed between 3 and 6 months from the closure procedure, a residual RLS ≥2 grade was found in 37 (16%) patients. Grade of pre-procedural spontaneous RLS (hazard ratio: 1.99; 95% confidence interval: 1.14 to 3.48; p = 0.016) shunt and PFO width (hazard ratio: 2.52; 95% confidence interval: 1.85 to 3.43; p < 0.001) were both found to be significantly associated with significant residual RLS at multivariable analysis. The presence of atrial septal aneurysm and its maximal bulge and of congenital remnants was not associated with significant residual RLS. CONCLUSIONS Percutaneous suture-mediated PFO closure is feasible in the majority of septal anatomies; however, PFO >5 mm in width and spontaneous large RLS are less likely to be closed with 1 stitch only.
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Affiliation(s)
| | | | | | | | - Maria Iamele
- Division of Cardiology, Sant'Eugenio Hospital, Rome, Italy
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23
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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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24
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Chaudhry‐Waterman N, Shapiro S, Thompson J. Use of the NobleStitch™ EL for the treatment of patients with residual right-to-left shunt following device closure of PFO. Clin Case Rep 2021; 9:1929-1932. [PMID: 33936617 PMCID: PMC8077419 DOI: 10.1002/ccr3.3906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/20/2020] [Accepted: 01/21/2021] [Indexed: 11/21/2022] Open
Abstract
The unique design of the NobleStitch™ EL allows it to be used to close residual defects following failed device PFO closure without impacting the integrity of previously placed double-disk Gore occluders.
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Affiliation(s)
| | | | - James Thompson
- INOVA Children’s HospitalFalls ChurchVAUSA
- Pediatrix Medical GroupINOVA Children’s HospitalFalls ChurchVAUSA
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25
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Filomena D, Cimino S, Maestrini V, Monosilio S, Birtolo LI, Vicenzini E, Mancone M, Fedele F, Agati L. The evolving role of echocardiography in the assessment of patent foramen ovale in patients with left-side thromboembolism. Echocardiography 2021; 38:657-675. [PMID: 33740289 DOI: 10.1111/echo.15018] [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: 12/14/2020] [Revised: 02/09/2021] [Accepted: 02/17/2021] [Indexed: 12/27/2022] Open
Abstract
Patent foramen ovale (PFO) is the most common congenital cardiac abnormality found approximately in 25% of the adult population The pathophysiological role of paradoxical embolization through the PFO in ischemic stroke is well established. "Self-expanding double disk" and, more recently, suture-based "deviceless" systems are used for PFO closure in the setting of secondary prevention after ischemic stroke likely related to paradoxical embolization. Ultrasound plays a significant role in PFO assessment, indication to treatment, intra-procedural guidance, and follow-up for those undergoing PFO closure. Three different techniques are frequently used for these purposes: transesophageal echocardiography, transthoracic echocardiogram, and transcranial Doppler. In this review, advantages and limits of these techniques are discussed in detail to improve our skills in detection and treatment of this important condition by using ultrasound.
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Affiliation(s)
- Domenico Filomena
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy
| | - Sara Cimino
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy
| | - Viviana Maestrini
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy
| | - Sara Monosilio
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy
| | - Lucia Ilaria Birtolo
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy
| | - Edoardo Vicenzini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Massimo Mancone
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy
| | - Francesco Fedele
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy
| | - Luciano Agati
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy
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26
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Musuku SR, Srikanthan A, Cherukupalli D, Donovan J, Shapeton AD, Winston B. NobleStitch EL PFO Closure Guided by Transesophageal Echocardiography. J Cardiothorac Vasc Anesth 2020; 36:549-552. [PMID: 33229166 DOI: 10.1053/j.jvca.2020.10.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/22/2020] [Accepted: 10/30/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Sridhar R Musuku
- The Department of Anesthesiology and Perioperative Medicine, Albany Medical Center, Albany, NY.
| | | | - Divya Cherukupalli
- The Department of Anesthesiology and Perioperative Medicine, Albany Medical Center, Albany, NY
| | - Jaqueline Donovan
- The Department of Anesthesiology and Perioperative Medicine, Albany Medical Center, Albany, NY
| | - Alexander D Shapeton
- Department of Anesthesia, Critical Care and Pain Medicine, Veterans Affairs Boston Healthcare System, West Roxbury, MA; Tufts University School of Medicine, Boston, MA
| | - Brion Winston
- Cardiology/ Interventional Cardiology, (Capital Cardiology Associates), Albany Medical Center, Albany, NY
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Trabattoni D, Gili S, Teruzzi G, Tamborini G. A severe right-to-left intracardiac shunt after NobleStitch failure: when a device is needed. Eur Heart J Case Rep 2020; 4:1-4. [PMID: 33204941 PMCID: PMC7649439 DOI: 10.1093/ehjcr/ytaa162] [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: 01/18/2020] [Revised: 02/24/2020] [Accepted: 05/19/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Transcatheter closure of patent foramen ovale (PFO) has been demonstrated to be superior to medical therapy in stroke prevention in selected patients. Beyond traditional permanent metallic devices, NobleStitch EL, a suture-based system, has been developed as a potential alternative. CASE SUMMARY A 50-year-old man underwent transcatheter closure of PFO with mild interatrial septal bulging and tunnel-like morphology with a NobleStitch device. A transthoracic echocardiography performed immediately after PFO closure showed residual shunt (RS), which persisted unchanged at staged controls, due to the inability of the delivery system to capture both the septum primum and the septum secundum. A second procedure was performed with the implantation of a Figulla Flex II 27/30 mm device, with no RS detectable at control echocardiography. DISCUSSION The NobleStitch device is interesting in its concept, but several pitfalls may be encountered during its deployment. Opposite to permanent metallic devices, RSs after the procedure are not expected to decrease over time and should be managed with a different approach.
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Affiliation(s)
| | - Sebastiano Gili
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea 4, Milan, Italy
| | - Giovanni Teruzzi
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea 4, Milan, Italy
| | - Gloria Tamborini
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea 4, Milan, Italy
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Structural heart intervention for prevention of embolic and hemorrhagic stroke: The new field of neurocardiology. J Cardiol 2020; 76:227-235. [PMID: 32482326 DOI: 10.1016/j.jjcc.2020.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 11/23/2022]
Abstract
Cardiogenic stroke (CS), characteristic causes of which include atrial fibrillation (AF) and right-to-left shunting due to a patent foramen ovale (PFO), has a well-known tendency to be associated with a more extensive ischemic area. This may result in severe neurological damage, and require strict life-long antithrombotic therapy. However, the fact that some patients have problems complying with the requirement for extended oral antithrombotic treatment has motivated the development of alternative approaches for stroke prevention. Heart structures such as the left atrial appendage (LAA) and PFO are potential targets for stroke prevention by way of device implantation. Several large prospective randomized clinical trials have demonstrated efficacy and safety of devices dedicated to this purpose. Percutaneous LAA occlusion for patients with non-valvular AF resulted in similar embolic event rates but significantly reduced bleeding events than did therapy with warfarin. Furthermore, PFO closure significantly reduced the frequency of recurrent embolic stroke relative to oral antithrombotic treatment. Current unsolved problems remaining in the application of these two strategies can be identified as the lack of standardized regimens for post-procedural antithrombotic therapy, ambiguity of determining the indications therefore, and the problem of device-related thrombus, which need to be investigated in depth in future. Cost-benefit analysis in comparison with standard medication is also required for each instance. A heart-brain multidisciplinary team approach, mandated to start such structural heart interventions, will become the future standard unit of personnel for stroke management, which promises to usher in the new field of neurocardiology.
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Gaspardone A, Sgueglia GA. Cryptogenic stroke over 60 years of age: should patent foramen ovale be closed? Eur Heart J Suppl 2020; 22:E82-E86. [PMID: 32523446 PMCID: PMC7270899 DOI: 10.1093/eurheartj/suaa067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Patent foramen ovale (PFO) is an anatomical communication between the left and the right atrium due to the lack of completed sealing of the fossa ovalis. Epidemiologic data, for the most part derived from young populations studies, suggested that PFO, allowing paradoxical embolization of thrombotic material from the venous to the arterial district, could play a significant role in the pathogenesis of cryptogenic ischaemic cerebral events. Recently, three randomized studies in patients ≤60 years of age demonstrated the superiority of percutaneous closure of PFO over medical antithrombotic treatment. Several studies, on the other hand, indicated that also in older patients with cryptogenic cerebral ischaemia, there was an higher prevalence of PFO in patients at low atherosclerosis and cardioembolic risk, and increased incidence of adverse cerebral events (mostly cryptogenic in patients treated medically, but likely due to a new cause in patients who had percutaneous closure of PFO). Advanced age is associated with more risk factors for deep vein thrombosis, and consequent paradoxical embolization through the PFO, so much so that careful consideration should be given to patients over the age of 60 years with cryptogenic stroke, as to not forgo the benefit of percutaneous closure of PFO, merely for anagraphic consideration. This consideration is particularly poignant in light of the more recent technical advances now available, such as direct percutaneous suture, mostly appealing for elderly patients, for its better tolerability and high safety both peri-procedural and during the follow-up, as well as the lack of necessity for antithrombotic treatment.
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Gaspardone A, De Santis A, Giannico MB, Sgueglia GA. Modified percutaneous suture‐mediated patent fossa ovalis closure for prevention of cerebral ischemic events. Catheter Cardiovasc Interv 2020; 96:638-642. [DOI: 10.1002/ccd.28936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 03/17/2020] [Accepted: 04/12/2020] [Indexed: 11/12/2022]
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Abstract
PURPOSE OF REVIEW To highlight recent advancements in the management of acute ischemic stroke patients with patent foramen ovale (PFO). RECENT FINDINGS One significant recent development was publication of long-term follow-up data from the RESPECT trial demonstrating evidence in favor of PFO closure over medical management. This data subsequently led to FDA approval for AMPLATZER™ septal occluder in the treatment of patients aged 18 to 60 years with both PFO and no other determined etiology for ischemic stroke, otherwise referred to as embolic stroke of undetermined source. Several subsequent closure trial results have recently been published, which also demonstrated benefit of PFO closure over medical management for ischemic stroke risk reduction in select patients. Based on the results of the more recently published REDUCE trial, the FDA granted approval for the GORE™ septal occluder. There is current, well-established evidence that PFO closure for secondary stroke prevention is effective in select cases.
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Interatrial Septal Tear After Patent Foramen Ovale Closure With the NobleStitch Device. JACC Cardiovasc Interv 2019; 12:e139-e140. [DOI: 10.1016/j.jcin.2019.05.040] [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] [Received: 04/01/2019] [Revised: 05/10/2019] [Accepted: 05/21/2019] [Indexed: 11/20/2022]
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Alkhouli M, Sievert H, Holmes DR. Patent foramen ovale closure for secondary stroke prevention. Eur Heart J 2019; 40:2339-2350. [PMID: 30957864 DOI: 10.1093/eurheartj/ehz157] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/30/2018] [Accepted: 03/05/2019] [Indexed: 01/10/2023] Open
Abstract
Abstract
Transcatheter closure of patent foramen ovale (PFO) in patients with cryptogenic stroke is gaining momentum after the recent publication of four randomized clinical trials suggesting its benefit. This article provides a contemporary overview of the anatomy and pathophysiology of PFO, the available diagnostic tools for the assessment and risk stratification of PFO, and the current and future landscape of PFO closure devices and their optimal utilization. It also summarizes the current data on PFO closure for stroke prevention, and discusses the remaining open issues in the field of PFO closure.
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Affiliation(s)
- Mohamad Alkhouli
- Division of Cardiology, School of Medicine, West Virginia University, 1 Medical Center Drive, Morgantown, WV, USA
| | - Horst Sievert
- Department of Medicine, CardioVascular Center Frankfurt, Seckbacher Landstraße 65, Frankfurt am Main, Germany
- Anglia Ruskin University, Cambridge Campus, East Rd, Cambridge, UK
- Yunnan Hospital Fuwai, Intersection of Shahe Beilu and Jinchuan Lu, Kunming, China
- University of California, 550 16th Street, San Francisco, CA, USA
| | - David R Holmes
- Department of Cardiology, Mayo Clinic School of Medicine, 200 1st St SW, Rochester, MN, USA
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O'Byrne ML, Levi DS. State-of-the-Art Atrial Septal Defect Closure Devices for Congenital Heart. Interv Cardiol Clin 2018; 8:11-21. [PMID: 30449418 DOI: 10.1016/j.iccl.2018.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This article describes current devices and indications for transcatheter device closure of atrial septal defect (TC-ASD) and patent foramen ovale in children and young adults. TC-ASD has a proven record of efficacy and safety, but device erosion raises questions about the relative safety of TC-ASD versus operative open heart surgical ASD closure. New devices for ASD closure with properties to reduce risk of erosion are being developed. Recent studies demonstrating superiority of patent foramen ovale device closure over medical therapy for cryptogenic stroke may lead to changes in practice for structural/interventional cardiologists. Care should be taken in extrapolating data to children and younger adults.
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Affiliation(s)
- Michael L O'Byrne
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Center for Pediatric Clinical Effectiveness, Leonard Davis Institute, University of Pennsylvania, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - Daniel S Levi
- Division of Cardiology, UCLA Mattel Children's Hospital, University of California Los Angeles Medical School, 200 UCLA Medical Plaza #330, Los Angeles, CA 90095, USA
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