TY - JOUR
T1 - European position paper on the management of patients with patent foramen ovale. General approach and left circulation thromboembolism
AU - Pristipino, Christian
AU - Sievert, Horst
AU - D'Ascenzo, Fabrizio
AU - Louis Mas, Jean
AU - Meier, Bernhard
AU - Scacciatella, Paolo
AU - Hildick-Smith, David
AU - Gaita, Fiorenzo
AU - Toni, Danilo
AU - Kyrle, Paul
AU - Thomson, John
AU - Derumeaux, Genevieve
AU - Onorato, Eustaquio
AU - Sibbing, Dirk
AU - Germonpré, Peter
AU - Berti, Sergio
AU - Chessa, Massimo
AU - Bedogni, Francesco
AU - Dudek, Dariusz
AU - Hornung, Marius
AU - Zamorano, Jose
AU - Evidence Synthesis Team
A2 - Søndergaard, Lars
N1 - The article has been co-published with permission in the European Heart Journal and EuroIntervention. All rights reserved. © The Author(s) 2018. The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. Either citation can be used when citing this article.
PY - 2019
Y1 - 2019
N2 - The presence of a patent foramen ovale (PFO) is implicated in the pathogenesis of a number of medical conditions; however, the subject remains controversial and no official statements have been published. This interdisciplinary paper, prepared with involvement of eight European scientific societies, aims to review the available trial evidence and to define the principles needed to guide decision making in patients with PFO. In order to guarantee a strict process, position statements were developed with the use of a modified grading of recommendations assessment, development, and evaluation (GRADE) methodology. A critical qualitative and quantitative evaluation of diagnostic and therapeutic procedures was performed, including assessment of the risk/benefit ratio. The level of evidence and the strength of the position statements of particular management options were weighed and graded according to predefined scales. Despite being based often on limited and non-randomised data, while waiting for more conclusive evidence, it was possible to conclude on a number of position statements regarding a rational general approach to PFO management and to specific considerations regarding left circulation thromboembolism. For some therapeutic aspects, it was possible to express stricter position statements based on randomised trials. This position paper provides the first largely shared, interdisciplinary approach for a rational PFO management based on the best available evidence.
AB - The presence of a patent foramen ovale (PFO) is implicated in the pathogenesis of a number of medical conditions; however, the subject remains controversial and no official statements have been published. This interdisciplinary paper, prepared with involvement of eight European scientific societies, aims to review the available trial evidence and to define the principles needed to guide decision making in patients with PFO. In order to guarantee a strict process, position statements were developed with the use of a modified grading of recommendations assessment, development, and evaluation (GRADE) methodology. A critical qualitative and quantitative evaluation of diagnostic and therapeutic procedures was performed, including assessment of the risk/benefit ratio. The level of evidence and the strength of the position statements of particular management options were weighed and graded according to predefined scales. Despite being based often on limited and non-randomised data, while waiting for more conclusive evidence, it was possible to conclude on a number of position statements regarding a rational general approach to PFO management and to specific considerations regarding left circulation thromboembolism. For some therapeutic aspects, it was possible to express stricter position statements based on randomised trials. This position paper provides the first largely shared, interdisciplinary approach for a rational PFO management based on the best available evidence.
U2 - 10.1093/eurheartj/ehy649
DO - 10.1093/eurheartj/ehy649
M3 - Journal article
C2 - 30358849
SN - 0195-668X
VL - 40
SP - 3182
EP - 3195
JO - European Heart Journal
JF - European Heart Journal
IS - 38
ER -