Page 21 - Journal of Structural Heart Disease Volume 2, Issue 5

Original Research Article
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devices to avoid embolization [13]. There was no cor- relation between the presence of a right atrial Chiari network and device size selection.
Objective selection of device size with the pro- posed scoring system could potentially improve both the safety and cost of percutaneous PFO closure. For example, three patients in our cohort required ex- tended procedure times to remove a device that was too small before implanting an appropriately sized device. Two of these patients had ASA on preproce- dure TTE, and were, therefore, more likely to require a larger device size. Prediction of device size require- ments with the sizing score could have limited u- oroscopy time and prevented the waste of a device that was too small.
Limitations
This was single-center, retrospective review of 36 patients who underwent percutaneous PFO clo- sure with the ASOC device. No other devices were studied. Alternative devices may need additional as- sessment for sizing. Only 21 patients had either TEE or ICE images available for retrospective review, further limiting the functional sample size of the study. Only two patients received the largest device (35 mm), which limits any conclusions regarding association with this device size. The choice of closure device size was made at the discretion of the interventional car- diologist; therefore, our ndings may be confounded by any subjective bias the operator applied in select- ing a closure device. In addition, the retrospective
nature of this study did not allow us to adequately assess whether the device size truly represents the optimal-sized device for each patient. Larger, pro- spective studies are needed to clarify this point.
Conclusions
The presence of ASA and a PFO tunnel length >10 mm were independently associated with the selection of a larger PFO closure device in this cohort of patients. A scoring system consisting of 1 point for the presence of ASA, 1 point for PFO tunnel length >10 mm, and 1 point for male sex was statistically as- sociated with the size of device implanted. Using the scoring thresholds de ned above, this score could be implemented to predict the appropriate device size required in a speci c patient. Use of this prediction score could both improve patient safety and lim- it costs. Further prospective studies are warranted to determine the accuracy of this sizing score and whether this its use limits residual shunt and other adverse events related to percutaneous PFO closure.
Con ict of Interest
Dr. Shah is a consultant/proctor for St. Jude Medi- cal. None of the other authors have con icts of inter- est to report.
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Journal of Structural Heart Disease, October 2016
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