Patients preoperatively diagnosed with patent foramen ovale (PFO) are at risk for ischemic stroke within the first 30 days after undergoing noncardiac surgery, according to a study published in JAMA.

Pauline Y Ng, MD, of the Department of Anesthesia, Critical Care, and Pain Medicine at Massachusetts General Hospital and Harvard Medical School in Boston, and colleagues conducted a retrospective group analysis to determine if a correlation is present between PFO and elevated ischemic stroke risk.

The investigators analyzed data from 182,393 patients older than age 18 who underwent noncardiac surgery with general anesthesia (patients with brain death were excluded). Of the total, 150,198 patients were eligible for investigation, and 1540 of this group were diagnosed with PFO prior to surgery (1%).

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The primary outcome was ischemic stroke occurring within 30 days of surgery, which was reported in 49 patients with PFO and in 801 patients without PFO (absolute risk difference [RD], 2.6%). Following adjustment, the investigators noted an elevated risk of ischemic stroke associated with patients with PFO compared with those without PFO (odds ratio [OR], 2.66) in the 30 days after surgery (adjusted absolute RD, 0.4%). Patients with PFO also had an elevated risk of large-vessel territory ischemia (relative risk [RR], 3.14).

The secondary outcomes were readmission and mortality rates within 30 days of surgery. Readmission was not significantly associated with PFO (OR, 1.15; adjusted absolute RD, 0.8%). Mortality rates were also insignificant (OR, 0.95; adjusted absolute RD, 0.01%).

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“An important finding from this study was that the PFO attributable risk of perioperative stroke was highest among patients with an otherwise low probability of perioperative ischemic stroke based on coexisting cardiovascular risk factors and intraoperative characteristics,” reported the authors. “Further research is needed to confirm these findings and to determine whether interventions would decrease this risk.”


  1. Ng PY, Ng AK, Subramaniam B, et al. Association of preoperatively diagnosed patent foramen ovale with perioperative ischemic stroke. JAMA. 2018 Feb 6. doi:10.1001/jama.2017.21899