Heart Defect Spotted During Surgery May Not Need Repair

July 14 (HealthDay News) -- Patients may not benefit from repair of a heart defect that's discovered during surgery for another condition, a new study has found.

The defect -- patent foramen ovale (PFO) -- is an opening in the upper chambers of the heart that failed to close naturally after birth.

Dr. Richard A. Krasuski and colleagues at the Cleveland Clinic found that patients whose PFO is discovered and repaired during cardiothoracic surgery may be at increased risk for post-surgery stroke. In addition, the repair of PFO in these cases offers no clear benefit in terms of short-term outcomes or long-term survival.

The study included almost 2,300 patients with a PFO that was discovered during cardiothoracic surgery. Of those, 639 had surgical repair of their PFO. Patients who had PFO repair were more likely to be women, to be younger, and to have a history of stroke or atrial fibrillation, according to the report published in the July 15 issue of the Journal of the American Medical Association.

Patients whose PFO was detected during surgery and those without PFO had similar rates of in-hospital stroke and hospital death, length of hospital stay, and days spent in the intensive care unit (ICU).

But the researchers found that patients who had their PFO repaired had an in-hospital stroke rate of 2.8 percent, compared to 1.2 percent among those who had a PFO but did not undergo repair. That means those who had PFO repair were 2.5 times more likely to have an in-hospital stroke.

Both groups had similar rates of hospital deaths, hospital length of stay, ICU length of stay and time on cardiopulmonary bypass. There was no difference in long-term survival, the study found.

"In summary, PFO is commonly detected during intraoperative imaging at the time of cardiothoracic surgery," Krasuski and colleagues wrote. "When incidentally discovered, it appears to have a benign short-term and long-term clinical course. While the number of events is small, there was no clear benefit of closure on short-term perioperative outcomes or longer-term mortality. The finding that repair may increase postoperative stroke risk should discourage routine surgical closure and foster further investigation to delineate whether there is any benefit in terms of long-term stroke prevention and which patients might benefit from this intervention," they concluded.


SOURCE: Journal of the American Medical Association, news release, July 14, 2009

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