1 Introduction In patients with patent foramen ovale (PFO) and cryptogenic stroke, percutaneous PFO closure proved to be superior to medical therapy for secondary prevention [12] . Standard percutaneous treatment consists in the positioning of umbrella-like double-disk devices which, despite a high efficacy, carry risk of early and late complications [2] . Moreover, large disks can preclude the transeptal re-access thus limiting the possibility for future interventions [3] . For these reasons, the concept of percutaneous suture-mediated deviceless PFO closure is gaining clinical interest, especially following the early follow-up safety and efficacy profile results [34] . Nevertheless, limited real world experiences regarding the use of suture-mediated PFO closures are available [45] . We therefore sought to assess the procedural characteristics, the effectiveness, and the safety profile of patent foramen ovale (PFO) closure with a suture-based device, the NobleStitch EL (HeartStitch, Fountain Valley, CA, USA) at mid-term follow-up amongst a highly selected population.