ALERT: This system is being upgraded on Tuesday December 12. It will not be available
for use for several hours that day while the upgrade is in progress. Deposits to DukeSpace
will be disabled on Monday December 11, so no new items are to be added to the repository
while the upgrade is in progress. Everything should be back to normal by the end of
day, December 12.
Prevalence and repair of intraoperatively diagnosed patent foramen ovale and association with perioperative outcomes and long-term survival.
Abstract
<h4>Context</h4>A recent survey suggested that cardiothoracic surgeons may alter planned
procedures to repair incidentally discovered patent foramen ovale (PFO). How frequently
this occurs and the impact on outcomes remain unknown.<h4>Objective</h4>To measure
the frequency of incidentally discovered PFO closure during cardiothoracic surgery
and determine its perioperative and long-term impact.<h4>Design, setting, and patients</h4>We
reviewed the intraoperative transesophageal echocardiograms of 13,092 patients without
prior diagnosis of PFO or atrial septal defect undergoing surgery at the Cleveland
Clinic, Cleveland, Ohio, from 1995 through 2006. Postoperative outcomes were prospectively
collected until discharge.<h4>Main outcome measures</h4>All-cause hospital mortality
and stroke were predetermined primary outcomes; length of hospital stay, length of
intensive care unit stay, and time on cardiopulmonary bypass were secondary outcomes.<h4>Results</h4>Intraoperative
PFO was diagnosed in 2277 patients in the study population (17%), and risk factors
for stroke were similar in patients with and without PFO. After propensity matching
was performed with the comparator groups, patients with PFO demonstrated similar rates
of in-hospital death (3.4% vs 2.6%, P = .11) and postoperative stroke (2.3% vs 2.3%,
P = .84). Surgical closure was performed in 639 PFO patients (28%), and surgeons were
more likely to close defects in patients who were younger (mean [SD] age, 61.1 [14]
vs 64.4 [13] years; P < .001), were undergoing mitral or tricuspid valve surgery (51%
vs 32%, P < .001), or had history of transient ischemic attack or stroke (16% vs 10%,
P < .001). Patients with repaired PFO demonstrated a 2.47-times greater odds (95%
confidence interval, 1.02-6.00) of having a postoperative stroke compared with those
with unrepaired PFO (2.8% vs 1.2%, P = .04). Long-term analysis demonstrated that
PFO repair was associated with no survival difference (P = .12).<h4>Conclusions</h4>Incidental
PFO is common in patients undergoing cardiothoracic surgery but is not associated
with increased perioperative morbidity or mortality. Surgical closure appears unrelated
to long-term survival and may increase postoperative stroke risk.
Type
Journal articleSubject
HumansPostoperative Complications
Echocardiography, Transesophageal
Incidental Findings
Treatment Outcome
Length of Stay
Cardiac Surgical Procedures
Cardiopulmonary Bypass
Intraoperative Period
Morbidity
Hospital Mortality
Risk
Survival Analysis
Aged
Middle Aged
Female
Male
Stroke
Foramen Ovale, Patent
Permalink
https://hdl.handle.net/10161/24977Published Version (Please cite this version)
10.1001/jama.2009.1012Publication Info
Krasuski, Richard A; Hart, Stephen A; Allen, Drew; Qureshi, Athar; Pettersson, Gosta;
Houghtaling, Penny L; ... Blackstone, Eugene (2009). Prevalence and repair of intraoperatively diagnosed patent foramen ovale and association
with perioperative outcomes and long-term survival. JAMA, 302(3). pp. 290-297. 10.1001/jama.2009.1012. Retrieved from https://hdl.handle.net/10161/24977.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
Collections
More Info
Show full item recordScholars@Duke
Richard Andrew Krasuski
Professor of Medicine
Dr. Richard Krasuski is Director of the Adult Congenital Heart Center at Duke University
Medical Center, the Director of Hemodynamic Research, and the Medical Director of
the CTEPH Program. He is considered a thought leader in the fields of pulmonary hypertension
and congenital heart disease. His research focus is in epidemiologic and clinical
studies involving patients with pulmonary hypertension and patients with congenital
heart disease. He is involved in multiple multicenter studies thr

Articles written by Duke faculty are made available through the campus open access policy. For more information see: Duke Open Access Policy
Rights for Collection: Scholarly Articles
Works are deposited here by their authors, and represent their research and opinions, not that of Duke University. Some materials and descriptions may include offensive content. More info