Transesophageal echocardiography‐guided versus fluoroscopy‐guided patent foramen ovale closure: A single center registry

Abstract

AbstractBackgroundPercutaneous closure of patent foramen ovale (PFO) is conventionally performed under continuous transesophageal echocardiographic (TEE) guidance. We aimed to evaluate whether a simplified procedural approach, including pure fluoroscopy‐guidance and final TEE control, as well as an aimed ‘next‐day‐discharge’ is comparable with the conventional TEE‐guided procedure in terms of periprocedural and intermediate‐term outcomes.MethodsAll patients who underwent a PFO closure at our center between 2010 and 2022 were retrospectively included. Prior to June 2019 cases were performed with continuous TEE guidance (TEE‐guided group). Since June 2019, only pure fluoroscopy‐guided PFO closures have been performed with TEE insertion and control just prior to device release (fluoroscopy‐guided group). We analyzed procedural aspects, as well as long term clinical and echocardiographic outcomes.ResultsIn total 291 patients were included in the analysis: 197 in the TEE‐guided group and 94 in the fluoroscopy‐guided group. Fluoroscopy‐guided procedures were markedly shorter (48 ± 20 min vs. 25 ± 9 min; p < .01). There was no difference in procedural complications, including death, major bleeding, device dislodgement, stroke or clinically relevant peripheral embolization between the two groups (.5% vs. 0%; p = .99). Hospital stay was also shorter with the simplified approach (2.5 ± 1.6 vs. 3.5 ± 1.2 days; p < .01), allowing 85% same‐day discharges during the last 12 months of observation period.At 6 ± 3 months echocardiographic follow‐up a residual leakage was described in 8% of the TEE‐guided cases and 2% of the fluoroscopy‐guided cases (p = .08).ConclusionWhile a complete TEE‐free PFO closure might have potential procedural risks, our approach of pure fluoroscopy‐guided with a brisk final TEE check seems to be advantageous in terms of procedural aspects with no sign of any acute or intermediate‐term hazard and it could offer an equitable compromise between the two worlds: a complete TEE procedure and a procedure without any TEE.