Assessment of Retinal Capillary Dropout after Transcatheter Aortic Valve Implantation by Optical Coherence Tomography Angiography

Jeanne Gunzinger,Sandrine Zweifel,Igal Moarof,Maximilian Wiest,Athina Pangalu,Joel Baur,Marco Piccirelli,Fabian Nietlispach,Burbuqe Ibrahimi,Dominik Straumann

doi:10.3390/diagnostics11122399

Abstract

Transcatheter aortic valve implantation (TAVI) is an alternative to open heart surgery in the treatment of symptomatic aortic valve stenosis, which is often the treatment of choice in elderly and frail patients. It carries a risk of embolic complications in the whole cerebral vascular bed, which includes the retinal vasculature. The main objective was the evaluation of retinal emboli visible on optical coherence tomography angiography (OCTA) following TAVI. This is a prospective, single center, observational study enrolling consecutive patients over two years. Patients were assessed pre- and post-TAVI. Twenty-eight patients were included in the final analysis, 82.1% were male, median age was 79.5 (range 52–88), median BCVA was 82.5 letters (range 75–93). Eight patients (28.6%) presented new capillary dropout lesions in their post-TAVI OCTA scans. There was no statistically significant change in BCVA. Quantitative analysis of macular or peripapillary OCTA parameters did not show any statistically significant difference in pre- and post-intervention. In conclusion, capillary dropout lesions could frequently be found in patients after TAVI. Quantitative measurements of macular and peripapillary flow remained stable, possibly indicating effective ocular blood flow regulation within the range of left ventricular ejection fraction in our cohort.

Highlights

This is a prospective, single center, observational study, approved by the institutional review board approved this study (Cantonal Ethics Committee, Canton of Zurich, Switzerland, BASEC-No 2017-00641) and carried out in accordance with principles of the Declaration of Helsinki (DoH) and the Essentials of Good Epidemiological Practice issued by Public Health Switzerland (EGEP)
All inpatients receiving transcatheter aortic valve implantation (TAVI) between June 2017 and November 2019 at the Heart Center at the University Hospital Zurich (USZ) with a minimal best-corrected visual acuity (BCVA) of 50 letters in both eyes and no contraindication for magnetic resonance imaging (MRI) were eligible for inclusion
All images were assessed for new capillary dropouts after Transcatheter aortic valve implantation (TAVI)

Summary

Introduction

Transcatheter aortic valve implantation (TAVI) is an alternative to open heart surgery in the treatment of symptomatic aortic valve stenosis [1]. A crimped bioprosthetic valve is delivered to the native aortic valve annulus on a stent, where the valve stent is expanded, pushing the native aortic valve aside. The procedure can be performed in local anesthesia. TAVI is the treatment of choice for the elderly and often multimorbid patient. Perioperative risk for embolic complication (mostly collagenous tissue or thrombotic material) [1] is high: postoperative stroke affects 3.3% (1.4% to 9%) of patients [2,3,4], while clinically silent ischemic lesions in the brain appear in 70–80% of patients [5,6,7]

Methods

Results

Conclusion