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Nirodhini Narendran, William Fusi-Rubiano, Andrew Smallwood, Randhir Chavan, Yit C. Yang, Saib Khogali, James Cotton; Retinal Embolic events following Transcatheter Aortic Valve Implantation (TAVI) for Aortic Stenosis.. Invest. Ophthalmol. Vis. Sci. 2016;57(12):91.
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© ARVO (1962-2015); The Authors (2016-present)
TAVI is an established treatment for patients with severe symptomatic aortic stenosis but is complicated by subclinical cerebral emboli, in >75% of patients. This study aimed to investigate for the first time, the occurrence of retinal embolic events following TAVI.
Following informed consent, patients were screened prior to TAVI to exclude those with: history of previous retinal occlusion; ocular conditions making detection of retinal emboli difficult; contraindication to dilated pupil examination and retinal photography, any condition making transfer to ophthalmic department unsafe prior to and after TAVI and history of diabetes. Preoperatively, patients had full ophthalmic examination including confrontational field testing, fundus examination and retinal photography. Post-operatively, patients underwent bedside ophthalmic examination with confrontational field testing and dilated direct and indirect ophthalmoscopy on day 2 and final, full ophthalmic examination on day 30. New retinal microvascular abnormalities and emboli were documented with retinal photography.
20 patients were enrolled over 24 months, mean age 82 years (68-93). Technical and clinical success of the procedure was evident in all patients, with no in-hospital mortality. All patients underwent ophthalmic examination preoperatively and at 48 hours, 19 patients underwent follow up exam at 30 days. One patient had evidence of retinal embolus pre TAVI which was still evident on day 2. Two patients had new unilateral retinal emboli and one patient had unilateral splinter haemorrhage on day 30. Another patient developed a clinical stroke, but had no evidence of retinal embolus at any timepoint. No patients suffered a significant change in visual acuity or intra ocular pressure.
New retinal events were identified post TAVI in 15% of patients (n=3). All events occurred between 48 hours and 30 days, suggesting that they were not acute procedural emboli, the source could be the aorta or the valve itself. There may be a need to reduce the risk of embolic events by optimizing anti thrombus therapy cover during the peri-operative period.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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