Increased Risk of Perioperative Ischemic Stroke in Patients Who Undergo Noncardiac Surgery with Preexisting Atrial Septal Defect or Patent Foramen Ovale

Pedro A. Villablanca, Alejandro Lemor, Chak Yu So, Guson Kang, Tarun Jain, Tanush Gupta, Tomo Ando, Divyanshu Mohananey, Sagar Ranka, Dagmar F. Hernandez-Suarez, Pablo Michel, Tiberio Frisoli, Dee Dee Wang, Marvin Eng, William O'Neill, Harish Ramakrishna

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Objectives: To evaluate whether a preoperative diagnosis of atrial septal defect (ASD) or patent foramen ovale (PFO) is associated with perioperative stroke in noncardiac surgery and their outcomes. Design: Retrospective cohort analysis. Setting: United States hospitals. Participants: Adults patients (≥18 years old) who underwent major noncardiac surgery from 2010 to 2015 were identified using the Healthcare Cost and Utilization Project's National Readmission Database. Interventions: Preoperative diagnosis of ASD or patent foramen ovale. Measurements and Main Results: Among the 19,659,161 hospitalizations for major noncardiac surgery analyzed, 12,248 (0.06%) had a preoperative diagnosis of ASD/PFO. Perioperative ischemic stroke occurred in 723 (5.9%) of patients with ASD/PFO and 373,291 (0.02%) of those without ASD/PFO (adjusted odds ratio [aOR], 16.7; 95% confidence interval [CI]: 13.9-20.0). Amongst the different types of noncardiac surgeries, obstetric, endocrine, and skin and burn surgery were associated with higher risk of stroke in patients with pre-existing ASD/PFO. Moreover, patients with ASD/PFO also had an increased in-hospital mortality (aOR, 4.6, 95% CI: 3.6-6.0), 30-day readmission (aOR, 1.2, 95% CI: 1.04-1.38), and 30-day stroke (aOR, 7.2, 95% CI: 3.1-16.6). After adjusting for atrial fibrillation, ischemic stroke remained significantly high in the ASD/PFO group (aOR: 23.7, 95%CI 19.4-28.9), as well as in-hospital mortality (aOR: 5.6, 95% CI 4.1-7.7), 30-day readmission (aOR: 1.19, 95%CI 1.0-1.4), and 30-day stroke (aOR: 9.3, 95% CI 3.7-23.6). Conclusions: Among adult patients undergoing major noncardiac surgery, pre-existing ASD/PFO is associated with increased risk of perioperative ischemic stroke, in-hospital mortality, 30-day stroke, and 30-day readmission after surgery.

Original languageEnglish (US)
Pages (from-to)2060-2068
Number of pages9
JournalJournal of Cardiothoracic and Vascular Anesthesia
Issue number8
StatePublished - Aug 2020


  • atrial septal defect
  • non-cardiac surgery
  • patent foramen ovale
  • stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine


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