Microtransesophageal echocardiographic guidance of patent foramen ovale percutaneous closure

Abstract

Introduction

The important growth in the number of percutaneous patent foramen ovale (PFO) closure procedures requires to find alternatives to conventional guidance by transesophageal echocardiography (TEE) with general anesthesia (GA). The micro-TEE monitoring, with local anesthesia, could allow a reliable guidance with a reduced procedural length, without the need for GA. The objective of this study is to evaluate the effectiveness and safety of PFO closure guided by micro-TEE compared to conventional TEE under GA.

Method

This retrospective single-center observational study included all consecutive patients admitted to the Pitié-Salpêtrière hospital, from January 2019 to June 2021 for PFO closure. The type of guidance was based on PFO's morphological characteristics and patient's choice. The primary endpoint was the successful implantation of at least one prosthesis without significant residual shunting (≤ grade 1). Key secondary endpoints were the procedure duration and periprocedural complications.

Results

A total of 237 patients (44% of female, mean age: 50 ± 14 years) were included, with TEE and micro-TEE guidance in 174 (73%) and 63 (27%) cases, respectively. Smaller devices (i.e. Amplatzer PFO occluder™ 18/25 or Occlutech Figulla Flex II 23/25™) were more frequently implanted among patients with micro-TEE compared to TEE guidance, with 59% vs. 44% respectively (P = 0.04). Overall, there was no case of procedural failure and the primary endpoint was obtained in 158 (91%) and 60 (95%) patients with TEE and micro-TEE guidance, respectively (P = 0.27). Procedural duration was shorter with micro-TEE guidance [median time 8 (7–11)min versus 21 (16–27)min, P = 0.01]. The rate of periprocedural complications was low (1.3% overall) and limited to periprocedural atrial arrythmia, without significant differences in both groups (P > 0.99).

Conclusion

Micro-TEE guidance may result in safe and shorter PFO percutaneous closure compared to TEE guidance with GA. These results must be confirmed on larger cohorts. TEE and micro-TEE durations (Fig. 1).