The Evolution of PFO Closure: From Permanent Metal to Bioresorbable Solutions
For decades, the standard of care for transcatheter closure of a patent foramen ovale (PFO) has relied on permanent metallic implants, primarily constructed from nitinol (a nickel-titanium alloy). While these devices have proven highly effective in reducing the risk of recurrent cryptogenic stroke, they are not without long-term concerns. Permanent metallic structures in the heart carry inherent risks, including nickel hypersensitivity, late-onset atrial arrhythmias, thrombus formation on the device surface, and the rare but catastrophic complication of cardiac erosion.
The quest for a ‘leave nothing behind’ approach has led to the development of biodegradable technology. The recent publication of the trial by Zhang et al. in Circulation (2026) marks a significant milestone in this journey, providing the first randomized controlled evidence that a novel biodegradable PFO closure device can match the performance of traditional nitinol-based occluders while eventually resorbing into the body.
