SPC365

Having Closure That Lasts – Long-Term Safety and Efficacy of PFO Occlusion

Session: Sessão de Posters 38 - Encerramento estrutural e desfechos cirúrgicos: do PFO ao bloco operatório
Speaker: João Martins Neves

Congress: CPC 2026
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.3 Non-coronary Cardiac Intervention
Session Type: Posters Eletrónicos
FP Number: ---
Authors: João Martins Neves; Diogo Ferreira; Ana Rita Andrade; João Silva Marques; Miguel Nobre Menezes; Pedro Cardoso; Fausto J. Pinto; Ana Rita Francisco
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"><strong>Introduction:</strong></span></span></span><br />
<span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000">Patent foramen ovale (PFO) closure is an established treatment option for patients (pts) with a history of cryptogenic stroke or transient ischemic attack (TIA) in whom the PFO is considered to have a causal role. Current guidelines recommend patient selection based on clinical, anatomical, and imaging characteristics to estimate the likelihood of PFO-related stroke. Despite growing evidence from randomized trials demonstrating the benefit of PFO closure in selected populations, real-world data on long-term outcomes, particularly across different levels of causal probability, remain limited.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"><strong>Aim</strong></span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000">: </span></span></span><br />
<span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000">To report the experience of PFO closure at a single center and to evaluate long-term clinical outcomes.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"><strong>Methods</strong></span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000">:</span></span></span><br />
<span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000">Single-center, retrospective study of consecutive pts who underwent percutaneous PFO closure due to stroke or TIA from 2011 to July 2025. Demographic, clinical, and imaging data were collected from medical records. Kaplan&ndash;Meier survival analysis was used to estimate recurrence-free survival according to ROPE score and Pascal classification.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"><strong>Results:</strong></span></span></span><br />
<span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000">A total of 330 pts were included (mean age 50 years, 51% female). The most frequent risk factors were dyslipidemia (47%), hypertension (36%) and smoking history (35%). History of migraine, previous venous thromboembolism and thrombophilia had been reported in 14%, 9% and 8% of pts, respectively. Stroke (median NIHSS 3) or TIA were the main indications for closure (75% and 25%, respectively). The mean ROPE score was 6&plusmn;2. According to Pascal classification, 14% of pts&rsquo; events were classified as &ldquo;unlikely&rdquo;, 58% as &ldquo;possible,&rdquo; 28% as &ldquo;probable,&rdquo; and 1% as &ldquo;highly probable&rdquo; PFO-related.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000">All pts were submitted to PFO closure with an Amplatzer&reg; PFO Occluder or Amplatzer&reg; Talisman Occluder. Mean procedural time was 56 minutes. Most pts were discharged on double antiplatelet therapy or oral anticoagulation alone, with no severe major bleeding complications reported.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000">During a mean follow-up time of 3 years, a total of 13 stroke/TIA recurrences were recorded after PFO closure. A recurrent event occurred earlier in pts with low ROPE score (</span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"><strong>&le;</strong></span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#0a0a0a"><span style="background-color:#ffffff">7</span></span></span></span><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000">) and &ldquo;unlikely&rdquo; / &ldquo;possible&rdquo; Pascal classification, although differences were not statistically significant.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000"><strong>Conclusion:</strong></span></span></span><br />
<span style="font-size:12pt"><span style="font-family:'Times New Roman',serif"><span style="color:#000000">PFO closure was associated with excellent procedural safety and low long-term recurrence rates. Although earlier recurrence was observed sooner in pts with lower causal probability, statistical significance was not reached &ndash; likely reflecting the small number of events. These findings underscore both the overall effectiveness of PFO closure in routine practice and the robustness of outcomes achieved through structured patient selection and procedural expertise.</span></span></span></p>

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