Patient-specific flow simulation analysis to predict device-related thrombosis in left atrial appendage occluders

Introduction and objectives: Left atrial appendage occlusion (LAAO) can be an efficient treatment to prevent strokes in patients who suffer from atrial fibrillation, especially those at risk of bleeding. A non-negligible number of patients treated with LAAO develop device-related thrombosis (DRT) af...

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Autores: Mill, Jordi, Agudelo, Victor, Li, Chi Hion, Noailly, Jérôme, Freixa, Xavier, Camara, Oscar, Arzamendi, Dabit
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2021
País:España
Institución:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repositorio:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:recercat.cat:10230/53672
Acceso en línea:http://hdl.handle.net/10230/53672
https://doi.org/10.24875/RECICE.M21000224
Access Level:acceso abierto
Palabra clave:Device-related thrombosis
Flow simulation
Left atrial appendage occlusion
Patient-specific
Trombosis relacionada con el dispositivo
Simulaciones de flujo
Cierre de la orejuela izquierda
Personalización del paciente
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oai_identifier_str oai:recercat.cat:10230/53672
network_acronym_str ES
network_name_str España
repository_id_str
dc.title.none.fl_str_mv Patient-specific flow simulation analysis to predict device-related thrombosis in left atrial appendage occluders
title Patient-specific flow simulation analysis to predict device-related thrombosis in left atrial appendage occluders
spellingShingle Patient-specific flow simulation analysis to predict device-related thrombosis in left atrial appendage occluders
Mill, Jordi
Device-related thrombosis
Flow simulation
Left atrial appendage occlusion
Patient-specific
Trombosis relacionada con el dispositivo
Simulaciones de flujo
Cierre de la orejuela izquierda
Personalización del paciente
title_short Patient-specific flow simulation analysis to predict device-related thrombosis in left atrial appendage occluders
title_full Patient-specific flow simulation analysis to predict device-related thrombosis in left atrial appendage occluders
title_fullStr Patient-specific flow simulation analysis to predict device-related thrombosis in left atrial appendage occluders
title_full_unstemmed Patient-specific flow simulation analysis to predict device-related thrombosis in left atrial appendage occluders
title_sort Patient-specific flow simulation analysis to predict device-related thrombosis in left atrial appendage occluders
dc.creator.none.fl_str_mv Mill, Jordi
Agudelo, Victor
Li, Chi Hion
Noailly, Jérôme
Freixa, Xavier
Camara, Oscar
Arzamendi, Dabit
author Mill, Jordi
author_facet Mill, Jordi
Agudelo, Victor
Li, Chi Hion
Noailly, Jérôme
Freixa, Xavier
Camara, Oscar
Arzamendi, Dabit
author_role author
author2 Agudelo, Victor
Li, Chi Hion
Noailly, Jérôme
Freixa, Xavier
Camara, Oscar
Arzamendi, Dabit
author2_role author
author
author
author
author
author
dc.subject.none.fl_str_mv Device-related thrombosis
Flow simulation
Left atrial appendage occlusion
Patient-specific
Trombosis relacionada con el dispositivo
Simulaciones de flujo
Cierre de la orejuela izquierda
Personalización del paciente
topic Device-related thrombosis
Flow simulation
Left atrial appendage occlusion
Patient-specific
Trombosis relacionada con el dispositivo
Simulaciones de flujo
Cierre de la orejuela izquierda
Personalización del paciente
description Introduction and objectives: Left atrial appendage occlusion (LAAO) can be an efficient treatment to prevent strokes in patients who suffer from atrial fibrillation, especially those at risk of bleeding. A non-negligible number of patients treated with LAAO develop device-related thrombosis (DRT) after device implantation. Our study aimed to identify the key blood flow characteristics leading to DRT using patient-specific flow simulations. Methods: Patients treated with LAAO between 2014 and 2019 at a single center with preoperative and follow-up computerized tomography images and ultrasound imaging (US) were used to create patient-specific flow simulations. Amulet LAAO devices were implanted in the study patients. Flow simulations were blindly assessed to discard the presence of DRT in the follow-up imaging. Results: A total of 6 patients were processed in this pivotal study, half of them with DRT at the follow-up according to the imaging analysis. After a comprehensive analysis of the simulations, the most relevant in silico indices associated with DRT were the presence of stagnant blood flow, recirculation with low flow velocities (< 0.20 m/s) next to the device surface, and regions with high flow complexity combined with low wall shear stress. Conclusions: Patient-specific flow simulations of LAAO were successfully used to predict blood flow patterns with different device configurations. The results show the potential of the present modelling and simulation approach to recommend optimal settings capable of minimizing the risk of DRT.
publishDate 2021
dc.date.none.fl_str_mv 2021
2022
2022
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/10230/53672
https://doi.org/10.24875/RECICE.M21000224
url http://hdl.handle.net/10230/53672
https://doi.org/10.24875/RECICE.M21000224
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv REC: Interventional Cardiology. 2021;3(4):278-85.
info:eu-repo/grantAgreement/ES/2PE/RTI2018-101193-B-I00
dc.rights.none.fl_str_mv https://creativecommons.org/licenses/by-nc-nd/4.0
info:eu-repo/semantics/openAccess
rights_invalid_str_mv https://creativecommons.org/licenses/by-nc-nd/4.0
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv S. Hirzel Verlag (SHV)
publisher.none.fl_str_mv S. Hirzel Verlag (SHV)
dc.source.none.fl_str_mv reponame:Recercat. Dipósit de la Recerca de Catalunya
instname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
instname_str Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
reponame_str Recercat. Dipósit de la Recerca de Catalunya
collection Recercat. Dipósit de la Recerca de Catalunya
repository.name.fl_str_mv
repository.mail.fl_str_mv
_version_ 1869420053958492161
spelling Patient-specific flow simulation analysis to predict device-related thrombosis in left atrial appendage occludersMill, JordiAgudelo, VictorLi, Chi HionNoailly, JérômeFreixa, XavierCamara, OscarArzamendi, DabitDevice-related thrombosisFlow simulationLeft atrial appendage occlusionPatient-specificTrombosis relacionada con el dispositivoSimulaciones de flujoCierre de la orejuela izquierdaPersonalización del pacienteIntroduction and objectives: Left atrial appendage occlusion (LAAO) can be an efficient treatment to prevent strokes in patients who suffer from atrial fibrillation, especially those at risk of bleeding. A non-negligible number of patients treated with LAAO develop device-related thrombosis (DRT) after device implantation. Our study aimed to identify the key blood flow characteristics leading to DRT using patient-specific flow simulations. Methods: Patients treated with LAAO between 2014 and 2019 at a single center with preoperative and follow-up computerized tomography images and ultrasound imaging (US) were used to create patient-specific flow simulations. Amulet LAAO devices were implanted in the study patients. Flow simulations were blindly assessed to discard the presence of DRT in the follow-up imaging. Results: A total of 6 patients were processed in this pivotal study, half of them with DRT at the follow-up according to the imaging analysis. After a comprehensive analysis of the simulations, the most relevant in silico indices associated with DRT were the presence of stagnant blood flow, recirculation with low flow velocities (< 0.20 m/s) next to the device surface, and regions with high flow complexity combined with low wall shear stress. Conclusions: Patient-specific flow simulations of LAAO were successfully used to predict blood flow patterns with different device configurations. The results show the potential of the present modelling and simulation approach to recommend optimal settings capable of minimizing the risk of DRT.Introducción y objetivos: El cierre de la orejuela izquierda (COI) puede ser una alternativa de tratamiento eficaz para prevenir eventos cardiovasculares en pacientes con fibrilación auricular, en especial en aquellos con alto riesgo de sangrado. Sin embargo, algunos de estos pacientes en los que se realiza COI desarrollan trombosis relacionada con el dispositivo (TRD). Este estudio presenta las características del flujo sanguíneo que son clave en la formación de TDR, a partir de simulaciones personalizadas para cada paciente. Métodos: Para crear las simulaciones personalizadas se incluyeron en el estudio pacientes intervenidos de COI entre 2014 y 2019 en un único centro, de quienes se disponía de imágenes de tomografía computarizada previas al procedimiento y de seguimiento, así como de control ecocardiográfico. Para el COI se utilizaron los dispositivos Amulet. Las simulaciones se analizaron de forma ciega al diagnóstico de TRD. Resultados: En total se estudiaron 6 pacientes, de los que la mitad presentaban TRD según las imágenes del seguimiento clínico. Tras analizar los resultados de las simulaciones, los índices hemodinámicos asociados con TRD fueron la presencia de flujo estancado, las recirculaciones de sangre a velocidades bajas (< 0,20 m/s) cerca de la superficie del dispositivo y las regiones con alta complejidad de flujo y baja tensión de cizallamiento en la pared. Conclusiones: Las simulaciones de flujo personalizadas en pacientes con COI predijeron correctamente el diagnóstico clínico de TRD en todos los casos analizados. Los resultados obtenidos demuestran el potencial de los modelos personalizados para recomendar configuraciones óptimas del dispositivo y minimizar el riesgo de TRD.This work was supported by the Spanish Ministry of Science, Innovation and Universities under the Retos I+D (RTI2018-101193-B-I00), the Maria de Maeztu Units of Excellence (MDM-2015-0502), the Formation of Doctors (PRE2018-084062) and the Recruitment of Talents (RYC-2015-18888) programmes.S. Hirzel Verlag (SHV)202220222021info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdfhttp://hdl.handle.net/10230/53672https://doi.org/10.24875/RECICE.M21000224reponame:Recercat. Dipósit de la Recerca de Catalunyainstname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)InglésREC: Interventional Cardiology. 2021;3(4):278-85.info:eu-repo/grantAgreement/ES/2PE/RTI2018-101193-B-I00© 2021 Sociedad Española de Cardiología. Published by Permanyer Publications. This is an open access journal under the CC BY-NC-ND 4.0 licensehttps://creativecommons.org/licenses/by-nc-nd/4.0info:eu-repo/semantics/openAccessoai:recercat.cat:10230/536722026-05-29T05:05:01Z
score 15,811543

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