National survey regarding the management of an intraoperatively diagnosed patent foramen ovale during coronary artery bypass graft surgery

Objective: With the increased use of intraoperative transesophageal echocardiography (TEE), patent foramen ovale (PFO) has become a common finding during routine coronary artery bypass graft (CABG) surgery. This survey was designed to study potential differences in the management of intraoperatively diagnosed PFO.

Design: A written survey.

Setting: US university and community hospitals.

Participants: The authors randomly selected 50% of US cardiac surgeons listed in the Cardiothoracic Surgery Network Database (n = 734).

Interventions: A written survey was mailed to the participants. The survey questions included respondents’ use of TEE during CABG surgery, examination for a PFO with TEE, and management of intraoperatively diagnosed PFO in the CABG surgery.

Measurements and main results: Overall, 64% of individuals (468/734) responded to the survey request. TEE is available in the primary institution of 98.6% of respondents and used to search for a PFO in approximately one third of all CABG surgeries. During planned on-pump CABG surgery, 27.9% of respondents always close an intraoperatively diagnosed PFO, whereas 10.2% of respondents never close an intraoperatively diagnosed PFO. During planned off-pump CABG surgery, 27.6% of surgeons never change their plan, and 11% of respondents always convert the procedure to on-pump CABG to close the PFO. The majority of respondents decide whether to close a PFO based on the size of the PFO, the right atrial pressure, and a history of possible paradoxical embolism.

Conclusions: In the United States, TEE is used extensively during CABG surgery. There is significant variability in how intraoperatively diagnosed PFO is managed during CABG surgery.

Key words:  TEE , patent foramen ovale , PFO , coronary artery bypass grafting , CABG , combined procedures , cardiac surgery , survey