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Long-term Performance of Suture-mediated PFO Closure: Insights From Late PFO Reopening Cases
Session:
Sessão de Comunicações Orais 06 – Fechar as lacunas: soluções percutâneas na cardiopatia congénita e estrutural
Speaker:
Inês Gomes Campos
Congress:
CPC 2026
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
20. Congenital Heart Disease and Pediatric Cardiology
Subtheme:
20.4 Congenital Heart Disease – Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Inês Gomes Campos; Joel Monteiro; Bruno Bragança; Inês Oliveira; José Luís Ferraro; Mauro Moreira; Ana Rodrigo Costa; Rafaela G. Lopes; Marta Tavares Silva; João Carlos Silva; Rui André Rodrigues; Aurora Andrade
Abstract
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Background</strong>: Percutaneous suture-mediated patent foramen ovale (PFO) closure has emerged as a safe and effective procedure at short-term follow-up. However, long-term data show rates of significant residual shunt (SRS) up to 25%.</span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Aim</strong>: To assess the efficacy and long-term safety profile of suture-mediated PFO closure in the longest national registry.</span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="color:#000000"><strong>Methods</strong><span style="font-family:Calibri,sans-serif">: Single-center retrospective observational registry of consecutive patients admitted for percutaneous suture-mediated PFO closure between January 2020 and November 2025. Patient and baseline PFO echocardiographic characteristics were collected. Patients were followed up to 5 years (mean 854</span><span style="font-family:Symbol">±</span><span style="font-family:Calibri,sans-serif">523 days) and recurrence of SRS (grade</span><span style="font-family:Symbol">>=</span><span style="font-family:Calibri,sans-serif">2) and need for additional PFO intervention were recorded.</span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results</strong>: 79 patients were included (mean age 48.5<span style="font-family:Symbol">±</span>12.6 years, 55.7% female), 95% referred for cryptogenic stroke and transit ischemic attack, with high RoPE score (median 6). Median PFO length was 10.0mm (IQR 8.3), width 3.0mm (IQR 2.0) with baseline severe spontaneous shunt in 44.6%. Atrial septal aneurysm was present in 41.6%. </span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">The procedure showed an immediate (first 24 hours) SRS rate of 9.3%. </span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">In the first programmed echocardiogram, 25 patients (31.6%) showed SRS (median echocardiography follow-up time of 4.9 months). </span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">During long-term follow-up, 5 patients with previously negative bubble-test echocardiograms were found to have SRS due to late PFO reopening [median echocardiography follow-up time of 2.7 years (2.3-5.0 years)], mainly due to partial stitch detachment. One patient had PFO-related stroke recurrence and underwent device implantation. Three of the other patients were also submitted to device implantation, while one patient was deemed unsuitable for reintervention. </span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion</strong>: <span style="color:black">Although percutaneous suture-mediated PFO closure demonstrates excellent short-term outcomes, our findings highlight the occurrence of <strong><span style="font-family:Calibri,sans-serif">very late PFO reopening,</span></strong> up to 5 years, in patients with previously documented PFO closure. These results underscore the need for a <strong><span style="font-family:Calibri,sans-serif">prolonged and structured follow-up</span></strong> to ensure adequate long-term efficacy and safety.</span></span></span></span></p>
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