Toward a minimalist strategy for PFO closure: outcomes and patient experience from 205 ICE-guided procedures performed under local anesthesia and early discharge

Patent foramen ovale (PFO) closure is an established treatment for secondary prevention after PFO-related stroke. Traditionally guided by transesophageal echocardiography (TEE) under general anesthesia, the procedure can now be performed using intracardiac echocardiography (ICE) under local anesthesia, supporting a minimalist and potentially outpatient approach. We retrospectively analyzed 205 consecutive patients who underwent ICE-guided PFO closure at Dijon University Hospital between 2018 and 2023. All procedures were performed under local anesthesia, without TEE or anesthesiology support. Procedural success, complications, discharge timing, and patient-reported comfort were evaluated, with clinical follow-up assessing recurrent events. Procedural success was achieved in 100% of patients, with a mean duration of 56 ± 19 min from catheterization laboratory entry to exit. Most patients (94%) were discharged within 24 h of admission, including 44% who underwent the procedure on an outpatient basis. Complications were infrequent (3.4% minor vascular events; one device embolization). Patient comfort was excellent (mean 9.1 ± 1.7/10). At follow-up, no recurrent ischemic events were observed. ICE-guided PFO closure under local anesthesia enables a simplified, anesthesia-free, and highly tolerated procedural pathway. These findings support the adoption of a minimalist interventional approach to streamline PFO management and optimize patient experience.