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Optimizing Patient Selection For Percutaneous Suture-Mediated Patent Foramen Ovale Closure: External Validation of LASSO Score
Session:
Sessão de Posters 33 - Cardiopatia congénita e hipertensão pulmonar: da evidência à ação
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:
Posters Eletrónicos
FP Number:
---
Authors:
Inês Gomes Campos; Joel Monteiro; Bruno Bragança; Mauro Moreira; José Luís Ferraro; Ana Rodrigo Costa; Rafaela G. Lopes; Marta Tavares Silva; João Carlos Silva; Rui André Rodrigues; Aurora Andrade; Achilles Gaspardone
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 proven to be safe and effective at short-term follow-up. Longer-term data show non-negligible rates of significant residual shunt (SRS), underscoring the need for improved patient selection. LASSO score was recently proposed by <em>Gaspardone et al</em>, but lacks external validation.</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 validate LASSO score in the largest portuguese cohort of suture-mediated PFO closure patients and to compare it with the previously internally validated SWAT score.</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>Methods</strong>: Single-center retrospective observational registry of consecutive patients admitted for percutaneous suture-mediated PFO closure between January 2020 and November 2025. The recently proposed LASSO score (PFO length<7mm: 1 point; atrial septal aneurysm: 1 point, severe shunt with Valsalva: 2 points; PFO opening >4mm: 2 points) was calculated. LASSO’s accuracy to predict SRS was compared with the previously derived SWAT score, developed and internally validated in the same population, using the DeLong test. </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%. Patients were followed up to 5 years (mean 854<span style="font-family:Symbol">±</span>523 days). </span></span></span></p> <p style="text-align:justify"><span style="color:#000000; font-family:Calibri,sans-serif; font-size:medium">Thirty patients (40.0%) had SRS (grade</span>>=<span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">2) at follow-up. Patients with SRS scored a significantly higher LASSO (2.52 vs 3.62, p=0.006). LASSO score showed good prediction accuracy (AUC 0.731; 95% IC 0.606-0.856). The previously derived SWAT score showed comparable discrimination (AUC 0.733; 95% IC 0.608-0.857, p = ns).</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>: This study provides the first external validation of the newly proposed LASSO score, confirming its discriminative performance in a real-world cohort. Its accuracy was comparable with the previously developed SWAT score, suggesting that both are valuable tools for optimizing patient selection for percutaneous suture-mediated PFO closure.</span></span></span></p>
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