Suture‐mediated closure of a patent foramen ovale during surgery without cardiopulmonary bypass

Abstract

A patent foramen ovale (PFO) is associated with an increased risk of recurrent ischemic strokes and transient ischemic attacks due to paradoxical emboli in patients with prior neurological events. We report a case of a surgical suture-mediated of a PFO closure without cardiopulmonary bypass in a patient with recurrent cerebral ischemic events, who was intolerant of medical therapy, was a poor candidate for catheter-based PFO closure, and presented as a potentially high risk for poor wound healing from traditional surgical closure.

Premere occlusion system for transcatheter patent foramen ovale closure: Mid‐term results of a single‐center registry

“…Although large ASA and multiperforated fossa ovalis remain at the risk of incomplete closure and atrial or aortic erosion because very often they need large devices implantation, selection of proper device for long channel PFO and hypertrophic rims are challenging due to the risk of device misalignment or failure. The optimal features for an ideal device are still unclear in such cases: new generation devices, such as the biodegradable Biostar or the Helex or the “nothing‐behind” devices (radiofrequency ablation and suture‐mediated device) for different reasons do not seem to be the best options for these anatomies [16–19].…”

“…Although the Biostar has reached the production step and have been demonstrated to be effective at least in simple anatomy but not in long‐tunnel PFO or large ASA, the latter techniques, probably suitable for long‐tunnel or hypertrophic rims, have been completely abandoned for the high rate of incomplete closure even in simple anatomies [18, 19]. Nowadays an increasing number of devices are becoming disposable on the market, but with some exceptions, such as the Premere Occlusion system or the Helix device, most used devices have a symmetrical opening philosophy and remain too rigid or too flexible to be properly adapted to long‐tunnel PFOs or hypertrophic rims.…”

When to close a patent foramen ovale

“…However, even with newer less invasive surgical techniques28 it imposes significantly higher morbidity on patients in comparison to transcatheter closure, and it should be reserved for high-risk patients unsuitable for transcatheter closure or those undergoing cardiac surgery for associated pathology.…”