Impact of transcatheter aortic valve implantation on retinal hemodynamics: a Doppler imaging study

Abstract

Objectives: After transcatheter aortic valve implantation (TAVI), various hemodynamic alterations occur due to increased cardiac output, which may influence retinal blood flow. This study aimed to evaluate the impact of TAVI on retinal artery dynamics by measuring Doppler parameters before and after the procedure.

Methods: In this prospective, single-centre study, patients scheduled for TAVI were evaluated using retinal Doppler within one week before TAVI, on the first postoperative day, and at one month post-procedure. The resistive index (RI) and pulsatility index (PI) measured retinal artery dynamics.

Results: The analysis included 50 patients undergoing TAVI. Significant changes in the right and left ophthalmic artery RI and PI (ROAPI, ROARI, LOAPI, and LOARI) and left central retinal artery RI and PI (LCRRI and LCRPI) were noted from pre-TAVI to the first postoperative day: ROAPI (1.71-1.90, p = 0.033), ROARI (0.82-0.90, p = 0.045), LOAPI (1.75-2.05, p = 0.042), LOARI (0.81-0.85, p = 0.040), LCRPI (1.50-1.57, p = 0.025), and LCRRI (0.76 to 0.79, p = 0.005). No significant differences were observed between preoperative and one-month postoperative values. Correlation analysis revealed significant associations between the mean aortic gradient and LOAPI (r = 0.447, p = 0.010) as well as LOARI (r = 0.383, p = 0.030).

Conclusion: Increased resistive indices on the first postoperative day suggest a transient autoregulatory response to altered hemodynamics after TAVI, possibly linked to chronic hypoperfusion from aortic stenosis. This study provides insights into ocular hemodynamic changes in the context of TAVI.

Keywords: Pulsatility index (PI); Transcatheter aortic valve implantation (TAVI); aortic stenosis; ocular hemodynamics; resistive index (RI); retinal Doppler imaging.