Résumé
Background: Patent foramen ovale (PFO) closure after a cryptogenic ischemic stroke (IS) and a transient ischemic attack (TIA) is recommended in Europe since 2017 to prevent recurrences. While closure lowering effect on recurrence rate is well proved, the repercussion of a persistent shunt through the closing device remains poorly known. Aim: To estimate persistent shunt rate after PFO closure at Nîmes and Montpellier University Hospitals between 2018 and 2020; assess the recurrence rate of cardiovascular events (IS, TIA, atrial fibrillation (AF) occurrence) after PFO closure and find a possible statistical link with the persistence of a shunt through the device. Methods: From January 2018 to December 2020, all patients with a PFO closure at Nîmes and Montpellier University Hospitals after a cryptogenic ischemic stroke or transient ischemic attack between January 2018 and December 2020 and at least a 6 months follow-up were retrospectively included. Clinical and procedure related data were collected, as well as the contrast sonography results and cardiovascular events. Results: 175 patients were included. The population was young (mean age 49.8 years) and mostly men (73%). Closure procedure complications were 1 severe bleeding and 2 occurrences of a per-procedural AF. Contrast sonographies were performed a mean of 11 months after closure procedure and had shown 21.1% (N=37) persistent right-left shunt. Effective PFO closure (defined in the CLOSE study as the absence of shunt or persistence of a minimal shunt) concerns 88% (N=154) of patients. During a median follow-up of 28.6 months, 2.9% of patients had AF occurrence and 1.7% had TIA, without any statistical link. No IS, systemic embolism or death were described. There was a higher right-left shunt persistence rate in women (31.3% vs 17.3%, p = 0.04) and the description of a left-right shunt through the PFO on pre-closure echography was statistically associated with the persistence of a right-left shunt (p = 0.003). The other anatomical characteristics (atrial septal aneurysm (ASA), maximal excursion of the ASA, size of right-left shunt) were not statistically associated with a persistent shunt. 24 Closure with 25mm devices (right atrial disc diameter) was associated with a lower persistent shunt rate than other sizes (p = 0.0004), but these small devices were probably used to close the simplest anatomy cases. Conclusion: PFO closure is a safe procedure, with a very high success rate (100% in our study). The persistence of a significant right-left shunt has been described in 12% of patients at 11 months mean follow-up and was not associated with the occurrence of cardiovascular events at 28.6 months mean follow-up. However, the follow-up remains limited, and more data are needed to find a link between the persistence of right-left shunt and the occurrence of new cardiovascular events and improve identification of favoring factors of a persistent shunt.