Improved Retinal Microcirculation After Cardiac Surgery in Patients With Congenital Heart Disease

Association of preoperative retinal microcirculation and perioperative outcomes in patients undergoing congenital cardiac surgery

BACKGROUND

Microcirculatory dysfunction is associated with increased morbidity and mortality in cardiac surgery patients. This study aimed to investigate the association between preoperative retinal microcirculation evaluated using optical coherence tomography angiography (OCTA) and perioperative outcomes in patients with congenital heart disease (CHD).

METHODS

This prospective, observational study was performed from May 2017 to January 2021. OCTA was used to automatically quantify the vessel density (VD) of the superficial capillary plexus, deep capillary plexus (DCP), and radial peripapillary capillary (RPC) preoperatively. The primary outcome was excessive postoperative bleeding, defined as bleeding volume > 75th percentile for 24-hour postoperative chest tube output. The secondary outcome was composite adverse outcomes, including one or more operative mortalities, early postoperative complications, and prolonged length of stay. The association between retinal VD and outcomes was assessed using Poisson regression.

RESULTS

In total, 173 CHD patients who underwent cardiac surgery were included (mean age, 26 years). Among them, 43 (24.9%) and 46 (26.6%) developed excessive postoperative bleeding and composite adverse outcomes, respectively. A lower VD of DCP (odds ratio [OR], 1.24; 95% confidence interval [CI], 1.08-1.43; P = 0.003) was independently associated with excessive postoperative bleeding, and a lower VD of RPC (OR, 1.97; 95% CI, 1.08-3.57; P = 0.027), and DCP (OR, 2.17; 95% CI, 1.08-4.37; P = 0.029) were independently associated with the postoperative composite adverse outcomes.

CONCLUSION

Preoperative retinal hypoperfusion was independently associated with an increased risk of perioperative adverse outcomes in patients with CHD, suggesting that retinal microcirculation evaluation could provide valuable information about the outcomes of cardiac surgery, thereby aiding physicians in tailoring individualized treatment.

Variations in Microcirculatory and Hemodynamic Parameters during Oncological Demolitive-Reconstructive Head and Neck Surgery: A Protocol for an Observational Study

(1) Background: Oncological demolitive-reconstructive surgeries in the head and neck region cause significant stress on patients' biohumoural, cardiac, and vascular systems, leading to disturbances in macrocirculatory and microcirculatory parameters. Traditional monitoring addresses the symptoms, but not the underlying cause. Microcirculatory assessments complement macrocirculatory monitoring, and bladder-catheter-based technology offers a better representation of central microcirculation. Flap reconstruction surgeries involve demolitive and reconstructive phases, requiring optimal tissue perfusion. The literature lacks a consensus on macro-microcirculation coupling, and there is no agreement on the use of vasopressors during head and neck surgeries. Evidence-based guidelines are lacking, resulting in variations in vasopressor administration. (2) Methods: This is a 12-month observational, prospective study conducted in a single center. It aims to evaluate the impact of macro-microcirculation coupling on clinical complications in head and neck surgery. All consecutive patients undergoing oncologic surgery requiring flap reconstruction and meeting the inclusion criteria will be enrolled. The study will utilize standard hemodynamic monitoring and bladder catheterization for measuring urine output and temperature. (3) Conclusions: The study aims to evaluate the coupling of macro- and microcirculation in head and neck surgeries, assess hemodynamic parameters and microcirculatory changes, and investigate their association with postoperative complications. The results can enhance patient care and surgical outcomes.

Early Diagnosis and Treatment of Coronary Heart Disease with Image Features of Optical Coherence Tomography under Adaptive Segmentation Algorithm

This research was aimed at exploring the application value of optical coherence tomography (OCT) images under adaptive segmentation algorithm in the early diagnosis of coronary heart disease (CHD). Eighty-two patients with CHD were included, who were to undergo coronary angiography (CAG) to confirm their condition. According to the diagnostic criteria of CHD in the American Coronary Artery Surgery Study (CASS), the patients were divided into the stable plaque group (41 cases) and unstable plaque group (41 cases). Besides, 20 healthy volunteers were selected as the control group, and all of them underwent OCT scans. On the basis of a fourth-order partial differential equation (PDE) and active contour (AC) model, a novel adaptive image segmentation algorithm PDE-AC was constructed and used for OCT image processing. No significant difference was found in general clinical data and serological indicators in the control group compared to the other two groups (P > 0.05). The lipid plaque length, degree of stenosis, and lipid pool angle, macrophages and intimal erosion, and plaque fissure in the unstable plaque group were highly greater than those in the stable plaque group. The fibrous cap thickness (FCT) was significantly thinner than that in the stable plaque group (P < 0.05). The diagnostic sensitivity, specificity, and accuracy of OCT under PDE-AC algorithm for CHD (91.53%, 84.08%, and 95.38%) were markedly higher than those of single OCT (83.46%, 75.11%, and 88.02%) (P < 0.05). In summary, OCT images under PDE-AC algorithm did better than simple OCT images in the diagnosis of CHD. Lipid plaque length, degree of stenosis, and lipid pool angle, macrophage and intimal erosion, plaque fissure, and FCT were important indicators for judging plaque stability, having the better clinical application value.