S. Lagrange, B. Mouhat, M. Besutti, O. Zbitou, R. Chopard, N. Meneveau
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The primary endpoint was the persistence of inter-atrial shunt (></span> <!-->10 microbubbles) 6 months after procedure, screened by contrast transthoracic ultrasound. The secondary objectives were: identification of risk markers for the persistence of inter-atrial shunt at 6 months, post-procedure complication rates and major cardiovascular events rate.</p></div><div><h3>Results</h3><p>Three hundred and eighty three patients were included: 303 (79%) in the conventional-GA group, 79 (21%) in the micro-AL group. The median follow-up was 28.0 (14.0–49.0) months. The average age was 49.9<!--> <!-->±<!--> <!-->12.6 years, 61.9% of men. There was no failure of PFO closure under AL. Six months after PFO closure, there was no difference in persistence of inter-atrial shunt between the conventional-GA group and the micro-AL group (29.3% vs. 25.5%, <em>P</em> <!-->=<!--> <span>0.583). There was no difference in the occurrence of complications related to the procedure between the 2 groups. In multivariate analysis, the presence of interatrial septal aneurysm [OR 1.88 (95% CI 1.07–3.31), </span><em>P</em> <!-->=<!--> <!-->0.029], ROPE score<!--> <!-->><!--> <!-->6 [OR 1.22 (1.04–1.43), <em>P</em> <!-->=<!--> <!-->0.015] and the occurrence of stroke following the procedure [OR 4.48 (1.12–17.87), <em>P</em> <!-->=<!--> <!-->0.034] were independently associated with the presence of a residual inter-atrial shunt at 6 months.</p></div><div><h3>Conclusion</h3><p>Our study identified that PFO closure under LA with TEE microprobe is feasible and safe. There was no difference in efficacy of 6-month FOP closure, regardless of conventional-GA or micro-AL method.</p></div>","PeriodicalId":8140,"journal":{"name":"Archives of Cardiovascular Diseases Supplements","volume":"15 3","pages":"Page 258"},"PeriodicalIF":18.0000,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Feasibility, efficacy and safety of PFO closure under local anesthesia with transoesophageal echocardiography microprobe: A single-center study of 383 patients\",\"authors\":\"S. Lagrange, B. Mouhat, M. Besutti, O. Zbitou, R. Chopard, N. Meneveau\",\"doi\":\"10.1016/j.acvdsp.2023.04.029\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><p><span>Percutaneous patent foramen ovale (PFO) closure is usually performed under </span>general anesthesia<span><span> (GA) with guidance by transesophageal echocardiograpy (TEE). Microrobe makes this procedure possible under local anesthesia (LA). Our study aimed to assess the feasibility, efficacy and safety of PFO closure under LA with </span>microprobe guidance.</span></p></div><div><h3>Method</h3><p><span>The aim was to evaluate the rate of PFO closure failure in patients who underwent a procedure under LA with a TEE microprobe (micro-LA group) vs. under GA with a conventional probe (conventional-GA group). The primary endpoint was the persistence of inter-atrial shunt (></span> <!-->10 microbubbles) 6 months after procedure, screened by contrast transthoracic ultrasound. The secondary objectives were: identification of risk markers for the persistence of inter-atrial shunt at 6 months, post-procedure complication rates and major cardiovascular events rate.</p></div><div><h3>Results</h3><p>Three hundred and eighty three patients were included: 303 (79%) in the conventional-GA group, 79 (21%) in the micro-AL group. The median follow-up was 28.0 (14.0–49.0) months. The average age was 49.9<!--> <!-->±<!--> <!-->12.6 years, 61.9% of men. There was no failure of PFO closure under AL. Six months after PFO closure, there was no difference in persistence of inter-atrial shunt between the conventional-GA group and the micro-AL group (29.3% vs. 25.5%, <em>P</em> <!-->=<!--> <span>0.583). There was no difference in the occurrence of complications related to the procedure between the 2 groups. 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引用次数: 0
摘要
经皮卵圆孔未闭(PFO)通常在全身麻醉(GA)下经食管超声心动图(TEE)指导下进行。在局部麻醉(LA)下，显微技术使这一过程成为可能。我们的研究旨在评估微探针引导下LA闭合PFO的可行性、有效性和安全性。目的是评估采用TEE微探针(micro-LA组)和采用常规探针(conventional-GA组)进行手术的患者PFO关闭失败率。主要终点是房内分流的持续存在(>10个微泡)术后6个月，经胸超声造影筛查。次要目标是:确定6个月时房内分流持续存在的危险标志，术后并发症发生率和主要心血管事件发生率。结果共纳入383例患者:常规- ga组303例(79%)，微量- al组79例(21%)。中位随访时间为28.0(14.0 ~ 49.0)个月。平均年龄49.9±12.6岁，男性占61.9%。AL下无PFO关闭失败。PFO关闭6个月后，常规- ga组与micro-AL组的房间分流持续时间无差异(29.3% vs. 25.5%， P = 0.583)。两组手术并发症发生率无差异。在多因素分析中，房间隔动脉瘤的存在[OR 1.88 (95% CI 1.07-3.31)， P = 0.029]， ROPE评分>6 [OR 1.22 (1.04-1.43)， P = 0.015]和手术后卒中的发生[OR 4.48 (1.12-17.87)， P = 0.034]与6个月时残留心房分流的存在独立相关。结论TEE微探针在LA下闭合PFO是可行且安全的。无论是常规ga法还是显微al法，6个月FOP闭合的疗效均无差异。
Feasibility, efficacy and safety of PFO closure under local anesthesia with transoesophageal echocardiography microprobe: A single-center study of 383 patients
Introduction
Percutaneous patent foramen ovale (PFO) closure is usually performed under general anesthesia (GA) with guidance by transesophageal echocardiograpy (TEE). Microrobe makes this procedure possible under local anesthesia (LA). Our study aimed to assess the feasibility, efficacy and safety of PFO closure under LA with microprobe guidance.
Method
The aim was to evaluate the rate of PFO closure failure in patients who underwent a procedure under LA with a TEE microprobe (micro-LA group) vs. under GA with a conventional probe (conventional-GA group). The primary endpoint was the persistence of inter-atrial shunt (> 10 microbubbles) 6 months after procedure, screened by contrast transthoracic ultrasound. The secondary objectives were: identification of risk markers for the persistence of inter-atrial shunt at 6 months, post-procedure complication rates and major cardiovascular events rate.
Results
Three hundred and eighty three patients were included: 303 (79%) in the conventional-GA group, 79 (21%) in the micro-AL group. The median follow-up was 28.0 (14.0–49.0) months. The average age was 49.9 ± 12.6 years, 61.9% of men. There was no failure of PFO closure under AL. Six months after PFO closure, there was no difference in persistence of inter-atrial shunt between the conventional-GA group and the micro-AL group (29.3% vs. 25.5%, P = 0.583). There was no difference in the occurrence of complications related to the procedure between the 2 groups. In multivariate analysis, the presence of interatrial septal aneurysm [OR 1.88 (95% CI 1.07–3.31), P = 0.029], ROPE score > 6 [OR 1.22 (1.04–1.43), P = 0.015] and the occurrence of stroke following the procedure [OR 4.48 (1.12–17.87), P = 0.034] were independently associated with the presence of a residual inter-atrial shunt at 6 months.
Conclusion
Our study identified that PFO closure under LA with TEE microprobe is feasible and safe. There was no difference in efficacy of 6-month FOP closure, regardless of conventional-GA or micro-AL method.
期刊介绍：
Archives of Cardiovascular Diseases Supplements is the official journal of the French Society of Cardiology. The journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles, editorials, and Images in cardiovascular medicine. The topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Additionally, Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.
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