Comparison of three echo-guidance techniques in percutaneous patent foramen ovale closure for stroke prevention: Conventional transoesophageal, microprobe transoesophageal and intracardiac echocardiography.

Cryptogenic stroke Intracardiac echography Microprobe transoesophageal echocardiography Multiplane transoesophageal echocardiography Patent foramen ovale Structural heart disease

Journal

Archives of cardiovascular diseases
ISSN: 1875-2128
Titre abrégé: Arch Cardiovasc Dis
Pays: Netherlands
ID NLM: 101465655

Informations de publication

Date de publication:
29 Sep 2023
Historique:
received: 26 04 2023
revised: 22 08 2023
accepted: 23 08 2023
medline: 15 10 2023
pubmed: 15 10 2023
entrez: 14 10 2023
Statut: aheadofprint

Résumé

Recent randomized trials have demonstrated a consistent reduction in recurrent stroke after percutaneous transcatheter patent foramen ovale closure versus medical therapy in patients with recent cryptogenic stroke. To compare the safety and efficacy of intracardiac echocardiography-guided and microprobe transoesophageal echocardiography-guided patent foramen ovale closure under local anaesthesia with transoesophageal echocardiography-guided patent foramen ovale closure under general anaesthesia. This prospective observational single-centre study included 194 consecutive patients scheduled for patent foramen ovale closure for secondary prevention of stroke from February 2018 to December 2019. Patients were asked to choose between an intracardiac echocardiography-guided, microprobe transoesophageal echocardiography-guided or transoesophageal echocardiography-guided procedure. The primary endpoint was the rate of successful closure at 6 months, defined as correct positioning of the device without severe shunt on 6-month contrast echocardiography. Successful closure was high and did not differ between groups: 97.8% (95% confidence interval 88.5-99.9%) in the intracardiac echocardiography-guided group versus 96.9% (95% confidence interval 83.8-99.9%) in the microprobe transoesophageal echocardiography-guided group and 99.1% (95% confidence interval 95.3-99.9%) in the transoesophageal echocardiography-guided group (P=0.63). Adverse events related to patent foramen ovale closure were low and did not differ between groups. Our preliminary real-world experience suggests good efficacy and safety with intracardiac echocardiography and microprobe transoesophageal echocardiography guidance compared with conventional transoesophageal echocardiography guidance for percutaneous transcatheter patent foramen ovale closure in recurrent stroke prevention.

Sections du résumé

BACKGROUND BACKGROUND
Recent randomized trials have demonstrated a consistent reduction in recurrent stroke after percutaneous transcatheter patent foramen ovale closure versus medical therapy in patients with recent cryptogenic stroke.
AIM OBJECTIVE
To compare the safety and efficacy of intracardiac echocardiography-guided and microprobe transoesophageal echocardiography-guided patent foramen ovale closure under local anaesthesia with transoesophageal echocardiography-guided patent foramen ovale closure under general anaesthesia.
METHODS METHODS
This prospective observational single-centre study included 194 consecutive patients scheduled for patent foramen ovale closure for secondary prevention of stroke from February 2018 to December 2019. Patients were asked to choose between an intracardiac echocardiography-guided, microprobe transoesophageal echocardiography-guided or transoesophageal echocardiography-guided procedure. The primary endpoint was the rate of successful closure at 6 months, defined as correct positioning of the device without severe shunt on 6-month contrast echocardiography.
RESULTS RESULTS
Successful closure was high and did not differ between groups: 97.8% (95% confidence interval 88.5-99.9%) in the intracardiac echocardiography-guided group versus 96.9% (95% confidence interval 83.8-99.9%) in the microprobe transoesophageal echocardiography-guided group and 99.1% (95% confidence interval 95.3-99.9%) in the transoesophageal echocardiography-guided group (P=0.63). Adverse events related to patent foramen ovale closure were low and did not differ between groups.
CONCLUSION CONCLUSIONS
Our preliminary real-world experience suggests good efficacy and safety with intracardiac echocardiography and microprobe transoesophageal echocardiography guidance compared with conventional transoesophageal echocardiography guidance for percutaneous transcatheter patent foramen ovale closure in recurrent stroke prevention.

Identifiants

DOI: 10.1016/j.acvd.2023.08.006 PMID: 37838576
pubmed: 37838576
pii: S1875-2136(23)00171-7
doi: 10.1016/j.acvd.2023.08.006
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2023 Elsevier Masson SAS. All rights reserved.

Auteurs

Iphigénie Reibel (I)

Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France.

Marie Hauguel-Moreau (M)

Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France.

Paul Guedeney (P)

Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France.

Georges Hage (G)

Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France.

Nadjib Hammoudi (N)

Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France.

Guillaume Duthoit (G)

Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France.

Michel Zeitouni (M)

Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France.

Benoit Lattuca (B)

Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France.

Mathieu Kernéis (M)

Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France.

Jean-Philippe Collet (JP)

Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France.

Johanne Silvain (J)

Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France.

Gilles Montalescot (G)

Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France. Electronic address: gilles.montalescot@aphp.fr.
Institut de Cardiologie, ACTION Study Group, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm UMRS_1166, 47-83, boulevard de l'Hôpital, 75013 Paris, France.

Classifications MeSH