Perioperative cerebral ischemic injury in PFO patients

Strokes are one of the most common and feared complications in patients undergoing surgery. The presence of a natural connection between the right and left heart at the atrial level, also called patent foramen ovale (PFO), as it is the case in about 25% of the population, is a potential risk factor for stroke. Therefore, the aim of this study is to investigate the incidence of stroke occurring during surgical procedures in patients with an existing PFO. For this purpose, 408 patients with planned surgery will be enrolled in the study. Patients will be evaluated for the presence of a PFO prior to surgery. After surgery, patients will undergo magnetic resonance imaging of the brain between postoperative days 2 and 7. Follow-up to identify any incidental neurological events will be performed at 30 days and one year. In addition, we plan to identify factors associated with stroke risk during surgical procedures in patients with PFO. Basic science analyses at the cellular level will be performed to improve risk prediction in this regard. The goal is to predict and ultimately prevent strokes associated with surgery in high-risk patients with PFO. Through this study, it will be possible to accurately estimate the risk of stroke in patients with and without PFO undergoing surgery. In the future, high-risk patients with PFO could undergo PFO closure to prevent strokes that may occur during surgery.

Sex-Based Differences Following Transcatheter Interventions for Septal Defects Every year, thousands of people are diagnosed with small openings in the walls of the heart - conditions known as atrial septal defects (ASD) and patent foramen ovale (PFO). These heart defects can increase the risk of stroke and other health complications. A common, minimally invasive procedure involving a small implant can close these openings. But do males and females benefit equally from this treatment? To find out, researchers funded by the Austrian Science Fund (FWF) studied hundreds of patients in Canada who underwent transcatheter closure of either an ASD or a PFO. The researchers aimed to establish whether biological sex influences recovery and whether long-term outcomes differ between males and females. The first study analysed 853 adults who received ASD closure. The results showed that, although females and males had different health profiles prior to the procedure - females more often reported symptoms such as breathlessness or palpitations, while males had more cardiovascular conditions such as high blood pressure - both groups benefited equally from the procedure. Improvements in heart function and the low risk of complications were consistent across sexes. Interestingly, women were found to have a slightly lower risk of developing atrial fibrillation after the procedure. The second study examined 783 patients who underwent PFO closure to prevent recurrent strokes. With an exceptionally long follow-up period of 14 years, this study found no difference between males and females in terms of stroke prevention, survival rates, or the incidence of new heart rhythm problems. The only notable difference was that men were more likely to require a pacemaker later on, suggesting that further investigation is needed. Why does this matter? These findings are important for ensuring that both women and men receive the best possible care. Historically, women have been underrepresented in medical research, particularly in cardiology. This study provides compelling evidence that current treatment methods are equally effective for both sexes, rendering different guidelines based on sex alone unnecessary. The results also support equal access to these life-saving procedures and emphasise the importance of incorporating sex-based analysis into future clinical studies. This will enable healthcare to become more precise, fair and personalised for everyone.