Long-term follow-up after percutaneous closure of patent foramen ovale for secondary prevention of paradoxical embolism in elderly patients (≥ 70 years)

PurposePatent foramen ovale (PFO) has been associated with cryptogenic stroke both in younger and older patients. Although percutaneous PFO closure has been shown safe and effective in patients > 55 years old, the long-term outcome of elderly patients (≥ 70 years) has not specifically been reported.Patients and methodsBetween November 1998 and October 2008, 839 consecutive patients (age 52 ± 13 years; 60% male) underwent percutaneous PFO closure for secondary prevention of paradoxical embolism (94% cerebral, 6% peripheral) using the Amplatzer PFO Occluder under fluoroscopic guidance only. Among them, 58 patients (7%) ≥ 70 years old were included in the present study.ResultsThe implantation procedure was successful in all patients. There were no procedural complications. Transesophageal echocardiography at 6 months, performed in 49 patients (84%), showed complete occlusion in 45 patients (92%), and a residual shunt in four patients (8%). During a mean follow-up of 5.2 ± 2.4 years (median 5.0; total 290 patient-years) three ischaemic strokes (two of them fatal) and five transient ischaemic attacks occurred. Freedom from recurrent ischaemic stroke, transient ischaemic attack, or peripheral embolism was 100% at 1 year, 86% at 5 years, and 82% at 10 years. The risk of recurrent thromboembolic events was significantly higher as compared to the patients < 70 years old (P < 0.001).ConclusionsThis study confirms the safety, feasibility, and clinical efficacy of percutaneous PFO closure guided by fluoroscopy only in elderly patients. Percutaneous PFO closure should be considered a therapeutic option in all patients with suspected paradoxical embolism, including the elderly.