This "all-comers" population documents the safety of percutaneous PFO closure. The cardiovascular event rate is slightly lower (0.26 per 100 patient years) compared to the recently published randomized trials and maintained persistently low rate for more than 8 years.

Objective To assess the effect of a 5‐hydroxytryptamine‐3 receptor antagonist (granisetron) on the use of sympathomimetic (cafedrine/theodrenaline) and uterotonic (oxytocin) agents after spinal anesthesia during cesarean delivery. Methods A retrospective observational analysis was conducted using intraoperative records (n=240) created at a single hospital in Germany between November 1, 2016, and July 31, 2017. The granisetron group (n=120) had received 3 mg of granisetron immediately before induction of spinal anesthesia. The control group (n=120) had not received granisetron. The primary endpoints were the intraoperative requirements for sympathomimetic and uterotonic agents. The secondary endpoints were parameters of intraprocedural maternal hemodynamic and clinical states. Results More patients in the granisetron group than in the control group received intraoperative cafedrine/theodrenaline (P=0.045), with the cumulative intraoperative dosage also increased in the granisetron group (P=0.016). By contrast, the cumulative intraoperative dose of oxytocin was lower in the granisetron group than in the control group (P<0.001). Decreases in heart rate and mean arterial blood pressure were lower in the granisetron group versus the control group (P=0.015 and P=0.002, respectively). Conclusion Treatment with granisetron immediately before cesarean delivery did not reduce the perioperative requirement for sympathomimetics but did reduce the need for uterotonics. Registered at ClinicalTrials.gov (NCT03318536)

(Int J Gynecol Obstet. 2019;145:361–366) Although spinal anesthesia (SPA) for cesarean delivery might improve outcomes for mother and child, it does carry the frequent side effects of hypotension and bradycardia, which in turn can lead to reduced uteroplacental perfusion. There are a few possible causes of hypotension during SPA and several strategies for its treatment. One possible option for preventing hypotension is the use of 5-HT3 receptor antagonists. Previous studies have found that ondansetron, a 5-HT3 receptor, had a positive effect on hemodynamic stability in obstetric studies. There is a lack of evidence for the use of 5-HT3 receptor antagonists to preemptively attenuate the adverse effects of SPA, however. This study aimed to evaluate a 5-HT3 receptor antagonist, granisetron, for its effects on the need for uterotonic agents and sympathomimetics after SPA.