Abstract
Background: Microcirculatory changes in congenital heart disease (CHD) patients undergoing cardiac surgery are not fully understood. We aimed to investigate the changes of retinal microcirculation in CHD patients after cardiac surgery by optical coherence tomography angiography (OCTA) and explore the association between retinal microcirculation and surgical outcome.Methods: This prospective observational study consisted of 71 CHD patients aged ≥6 years undergoing cardiac surgery including 19 cyanotic CHD (CCHD) and 52 acyanotic CHD (ACHD). Optical coherence tomography angiography (OCTA) was used to measure vessel density (VD) and capillary density (CD) of radial peripapillary capillary (RPC) and peripapillary, VD of superficial capillary plexus (SCP) and deep capillary plexus (DCP), thickness of retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) preoperatively and 1 month postoperatively. Transthoracic echocardiography was conducted to measure macrocirculation.Results: In CCHD patients, VD and CD of RPC and peripapillary increased postoperatively (all P < 0.05). In ACHD patients, VD of peripapillary, CD of RPC and peripapillary, and RNFL thickness increased postoperatively (all P < 0.05). VD of SCP and DCP, and GCC thickness did not change significantly in CHD patients after surgery. Lower preoperative retinal microvascular density was associated with longer cardiopulmonary bypass (CPB) time and postoperative length of stay (PLOS). No correlation was found between microcirculatory and macrohemodynamic parameters (all P > 0.05).Conclusions: Improved retinal microcirculation was observed after congenital cardiac surgery and impaired preoperative retinal microvasculature was associated with prolonged CPB time and PLOS, which might provide potential information about the outcome of congenital cardiac surgery.
Highlights
Advances in the surgical treatment of congenital heart disease (CHD) have substantially improved the overall survival of patients, the perioperative management and prediction of the surgical outcome remain challenging [1, 2]
It has been documented that microcirculation dysfunction was independently associated with adverse outcome in patients with valvular or coronary cardiac surgery using cardiopulmonary bypass (CPB), implying microcirculatory monitoring could provide the predictive value of surgical outcome [3, 4]
In this prospective observational study, we aimed to reveal the changes of postoperative retinal microcirculation in CHD patients and explore the association between preoperative retinal microcirculation and adverse outcome of congenital cardiac surgery
Summary
Advances in the surgical treatment of congenital heart disease (CHD) have substantially improved the overall survival of patients, the perioperative management and prediction of the surgical outcome remain challenging [1, 2]. It has been documented that microcirculation dysfunction was independently associated with adverse outcome in patients with valvular or coronary cardiac surgery using cardiopulmonary bypass (CPB), implying microcirculatory monitoring could provide the predictive value of surgical outcome [3, 4]. Optical coherence tomography angiography (OCTA) is a non-invasive, rapid imaging technique used to obtain high-resolution, three-dimensional images of the retinal microvasculature, and can be used to automatically quantify retinal microcirculatory perfusion at different layers [10]. Microcirculatory changes in congenital heart disease (CHD) patients undergoing cardiac surgery are not fully understood. We aimed to investigate the changes of retinal microcirculation in CHD patients after cardiac surgery by optical coherence tomography angiography (OCTA) and explore the association between retinal microcirculation and surgical outcome
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
