HealthDay News — For adults undergoing non-cardiac surgery, having a preoperatively diagnosed patent foramen ovale (PFO) is associated with increased risk of perioperative ischemic stroke, according to a study published in the Journal of the American Medical Association.

Pauline Y. Ng, MD, from Massachusetts General Hospital in Boston, and colleagues conducted a retrospective cohort study involving 182,393 consecutive adults undergoing non-cardiac surgery with general anesthesia. Participants had preoperatively diagnosed PFO, and were followed for perioperative ischemic stroke within 30 days of surgery.

The researchers found that 1540 of the 150,198 patient cases had a diagnosis of PFO before surgery. There were 850 ischemic strokes (0.6%) within 30 days of surgery: 3.2% and 0.5% among patients with and without PFO, respectively. Patients with PFO had a significantly increased risk of ischemic stroke compared to those without PFO, in adjusted analyses (OR, 2.66). The estimated risks of stroke were 5.9 and 2.2 per 1000 patients with and without PFO, respectively (adjusted absolute risk difference, 0.4%). The risks of large vessel territory stroke (relative risk ratio, 3.14) and a more severe stroke-related neurologic deficit, measured by the National Institute of Health Stroke Scale (median 4 vs 3), were increased for patients with PFO.

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“Further research is needed to confirm these findings and to determine whether interventions would decrease this risk,” the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.


Kasner SE, Messe SR. Is patent foramen ovale a risk for perioperative stroke? JAMA. 2018;319(5):446-447.