Patent foramen ovale and perioperative stroke in noncardiac surgery : a systematic review and meta-analysis

Article Article scientifique Méta-analyse Patent foramen ovale and perioperative stroke in noncardiac surgery : a systematic review and meta-analysis eng 2022-08-18 2022-12 author Rais Gaël Department of Acute Medicine, Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland. 440849 author Vassallo Paola Department of Clinical Neuroscience, Lausanne University Hospital, Lausanne, Switzerland. author Schorer Raoul Department of Acute Medicine, Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland. 594203 author Bollen Pinto Bernardo 0000-0002-1281-543X Department of Acute Medicine, Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland. 830219 Département d'anesthésiologie, pharmacologie et soins intensifs (APSIC) author Putzu Alessandro 0000-0002-4943-450X Department of Acute Medicine, Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland. Electronic address: Alessandro.Putzu@hcuge.ch. 989819 898-908 10.1016/j.bja.2022.06.036 35987705 0007-0912 https://www.sciencedirect.com/science/article/pii/S0007091222003609 Background: Patent foramen ovale (PFO) is associated with perioperative stroke in noncardiac surgery. The magnitude of this association was assessed in a systematic review and meta-analysis. Methods: Electronic databases were searched up to June 2022 for studies assessing the association between patent foramen ovale and perioperative stroke in adult patients undergoing noncardiac surgery. The primary analysis was limited to studies reporting effect estimates adjusted for significant clinical confounders. We calculated the adjusted odds ratio (aOR) and 95% confidence interval (CI). Results: We included nine retrospective and two prospective observational studies, including 21 257 082 patients. The presence of a patent foramen ovale was independently associated with stroke at 30 days after surgery (aOR=6.68 [95% CI: 3.51-12.73]; P<0.001) and at longest follow-up available (aOR=7.36 [95% CI: 3.56-15.21]; P<0.001). The odds of stroke at 30 days varied according to surgical specialty: neurosurgery (aOR=4.52 [95% CI: 3.17-6.43]), vascular surgery (aOR=7.15 [95% CI: 2.52-20.22]), thoracic surgery (aOR=10.64 [95% CI: 5.97-18.98]), orthopaedic surgery (aOR=11.85 [95% CI: 5.38-26.08]), general surgery (aOR=14.40 [95% CI: 10.88-19.06]), and genitourinary surgery (aOR=17.28 [95% CI: 10.36-28.84]). Conclusions: The presence of a patent foramen ovale is associated with a large and consistent increase in odds of stroke across all explored surgical settings. Prospective trials should further explore this association by systematically assessing patent foramen ovale and stroke prevalence and identifying a specific population at risk. This is crucial for the elaboration of prevention plans and may improve perioperative outcomes. Paradoxical embolism Patent foramen ovale Perioperative medicine Stroke Surgery Dewey 617 63 Département d'anesthésiologie, pharmacologie, soins intensifs et urgences 229 false British journal of anaesthesia 129 6 bc745ee1-b843-4699-98e6-8d68f8dee895 Article (Published version) Public PIIS0007091222003609.pdf 475437 application/pdf OA OTHER 5a610dad765577b71f5f7933086733303ef129c6ef59f5c061cc1092893403a7 1dab0524-aee4-4987-8b64-59bd4f5d1a4a Supplemental data Public 1-s2.0-S0007091222003609-mmc1.docx 6362292 application/vnd.openxmlformats-officedocument.wordprocessingml.document 9346bb6c9e9df101b73ae6f6b2b6ea1118c38e9a59cdb3ba4bfb9fcb7d3bd4d5 openAccess Faculté de médecine / Section de médecine clinique / Département d'anesthésiologie, pharmacologie, soins intensifs et urgences

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Patent foramen ovale and perioperative stroke in noncardiac surgery : a systematic review and meta-analysis	British journal of anaesthesia			2022	12	162

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Rais, Gaël