Rate, determinants and clinical impact of percutaneous closure success of patent foramen ovale-related hypoxemia

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Abstract Background Percutaneous closure of a patent foramen ovale (PFO) may be used to treat Platypnea-orthodeoxia syndrome (POS) and PFO-related refractory hypoxemia, however data on this procedure remain scarce. Purpose This study aims to assess the efficacy of percutaneous PFO closure in terms of improvement in dyspnea and gas exchange and to identify determinants of procedure failure and its impact on long-term outcomes. Methods This retrospective analysis included patients undergoing POS- or hypoxemia-related PFO closure in three French centers participating in the ongoing international AIR FORCE registry. Procedural success was defined by a device implantation without major complication (no death, no device embolization, no stroke) and an improvement in gas exchange (defined as a complete weaning from oxygen therapy, an increase in oxygen saturation ≥10% or partial pressure of oxygen (PaO2) > 15mmHg, or ambient air saturation > 93%) and/or an improvement in dyspnea defined by a ≥one-stage gain in dyspnea (evaluated by the NYHA or mMRC scale). Secondary outcomes included the rate of residual right-to-left shunt and long-term survival. Determinants of intervention failure were evaluated using multivariate logistic regression. Results Between October 2008 and February 2024, among 1748 patients undergoing PFO closure in the three centers, a total of 160 were treated for the correction of PFO-related hypoxemia. Procedural success was observed in 106/160(66%) patients. Independent determinants of procedural failure were chronic kidney failure (adjusted Hazard Ratio (aHR) 3.57; 95% confidence interval (CI) 1.20- 11.1; p=0.022) and the absence of transesophageal echocardiography (TEE) guidance during the procedure (HR 3.04; CI 1.20-7.75; p=0.018). A contrast transthoracic echocardiography was performed in 64 (40%) patients within 6 months with no significant difference in terms of large residual shunt between patients with or without procedural success. After a median follow-up of 20.5 [2.4-45.4] months, there was no difference in survival among patients presenting or not a procedural success (Figure 1). Conclusion In this large retrospective registry, PFO percutaneous closure for POS or PFO-related chronic hypoxemia led to an improvement in gas exchange or dyspnea in two-thirds of the cases.Kaplan meier curve

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