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Sex Differences in Clinical Characteristics and Outcomes After PFO Closure
Session:
Sessão de Posters 38 - Encerramento estrutural e desfechos cirúrgicos: do PFO ao bloco operatório
Speaker:
Emanuel de Oliveira
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:
Emanuel de Oliveira; Bernardo Cruz; Joana Conde Gonçalves; Catarina Martins da Costa; Gonçalo Pestana; Carla Sousa; Marta Tavares Silva; Rui André Rodrigues
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Background:</strong> </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Patent foramen ovale (PFO) is present in up to 25% of adults and accounts for approximately 5% of all strokes. Sex-specific differences in patient characteristics and outcomes after percutaneous PFO closure remain poorly understood. We evaluated demographic, anatomical and clinical outcome differences between men and women undergoing PFO closure.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong>: </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">This single-center retrospective study included consecutive patients who underwent PFO closure between January 1, 2020, and October 31, 2025. Patients were grouped by sex. Demographic, anatomical and clinical data were collected from electronic medical records and compared using appropriate statistical tests.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">A total of 234 patients were included (121 women, 113 men) with similar mean ages (51 vs. 49 years, p=0.345). The indication for closure did not differ between groups, with cryptogenic ischemic stroke being the most frequent indication in both sexes. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Most baseline comorbidities—including diabetes, hypertension, dyslipidemia, autoimmune disease and thrombophilia—were similar. Men were significantly more frequently smokers (10% vs. 21%, p=0.027), while women had a higher prevalence of atrial septal aneurysm (59% vs. 41%, p=0.013).<br /> The mean follow-up was similar in both groups (398 vs. 394 days, p=0.615). Although adverse outcomes were rare, two clinically relevant sex-related differences were observed: women experienced more all-cause hospitalizations after PFO closure (7 vs. 0, p=0.009) and had higher post-procedural mortality (5 vs. 0, p=0.028), all from non-cardiovascular causes. Importantly, women who died were substantially older than those who survived (73 vs. 50 years, p<0.001).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">No differences were observed in procedural complications, significant residual shunt, atrial fibrillation or stroke.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions:</strong> </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Despite similar baseline characteristics and closure indications, women demonstrated a higher-risk anatomical profile and significantly higher rates of hospitalizations and mortality after PFO closure. Although limited by low event numbers, these findings suggest meaningful sex-related differences that warrant further investigation.</span></span></p>
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