Eye of Stranger: Evaluate of Chorioretinal Microvascular Networks on Ventricular Assist Device

Purpose To evaluate microvascular architecture of eyes in cases with continuous-flow (CF) left ventricular assist device (LVAD) to find out the possible effects of LVADs over blood supply of end organs. Methods For each study eye, high resolution scans of chorioretinal microvascular networks were captured via optical coherence tomography angiography (OCTA); which is a novel noninvasive, dye free, three dimensional angiography technique using the movement of red blood cells within chorioretinal capillaries against static ocular tissue as an intrinsic contrast to generate flow imaging. Eyes with any ocular diseases and those depicted low quality OCTA images according to optic media opacities were excluded. Study group included the eyes of LVAD cases with a minimum two years of follow-up. Demographics and OCTA findings were recorded and statistically analyzed to find out possible alterations of retinal and choroidal blood supply between LVAD cases and the controls. Comparison of OCTA findings between patients with LVAD implantation by thoracotomy with anastomosis of the outflow graft to the descending aorta (DA group) and those with the standard approach (AA group) was the secondary end point. Results Twenty three eyes of 13 LVAD implanted cases and 21 eyes of 12 healthy controls were included. There was no statistical difference in age and gender distribution between two groups (p=0.945 and p=0.601, respectively). Mean central foveal thickness (CFT) and choroidal thickness (CT) were 228.0±17.0 µm and 314.5±50.8 µm in study group; whereas they were 223.0±13.0 µm and 256.1±36.1 µm in the controls (p=0.287 and p 0.05 for all). Among cases with LVAD implantation, any statistically significant difference was also not found in OCTA scores between DA and AA subgroups which comprised of 6 and 17 eyes, respectively. Conclusion Increased CT was found in patients underwent CF LVADs possibly due to raised capillary pressure in such cases. Except for CT measurements, similar scores of studied OCTA parameters between LVAD cases and the controls revealed that CF LVADs have not any negative impact over end organ blood supply in late term without any respect to being in either DA or AA subgroup.