In silico optimization of left a trial appendage occluder implantation using interactive and modeling tools

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• dc.contributor.author Aguado, Ainhoa M.
• dc.contributor.author Olivares Miyares, Andy Luis
• dc.contributor.author Yagüe, Carlos
• dc.contributor.author Silva, Etelvino
• dc.contributor.author Nuñez-Garcia, Marta
• dc.contributor.author Fernandez-Quilez, Álvaro
• dc.contributor.author Mill, Jordi
• dc.contributor.author Genua, Ibai
• dc.contributor.author Arzamendi, Dabit
• dc.contributor.author De Potter, Tom
• dc.contributor.author Freixa, Xavier
• dc.contributor.author Camara, Oscar
• dc.date.accessioned 2019-04-03T08:44:24Z
• dc.date.available 2019-04-03T08:44:24Z
• dc.date.issued 2019
• dc.description.abstract According to clinical studies, around one third of patients with atrial fibrillation (AF) will suffer a stroke during their lifetime. Between 70 and 90% of these strokes are caused by thrombus formed in the left atrial appendage. In patients with contraindications to oral anticoagulants, a left atrial appendage occluder (LAAO) is often implanted to prevent blood flow entering in the LAA. A limited range of LAAO devices is available, with different designs and sizes. Together with the heterogeneity of LAA morphology, these factors make LAAO success dependent on clinician's experience. A sub-optimal LAAO implantation can generate thrombi outside the device, eventually leading to stroke if not treated. The aim of this study was to develop clinician-friendly tools based on biophysical models to optimize LAAO device therapies. A web-based 3D interactive virtual implantation platform, so-called VIDAA, was created to select the most appropriate LAAO configurations (type of device, size, landing zone) for a given patient-specific LAA morphology. An initial LAAO configuration is proposed in VIDAA, automatically computed from LAA shape features (centreline, diameters). The most promising LAAO settings and LAA geometries were exported from VIDAA to build volumetric meshes and run Computational Fluid Dynamics (CFD) simulations to assess blood flow patterns after implantation. Risk of thrombus formation was estimated from the simulated hemodynamics with an index combining information from blood flow velocity and complexity. The combination of the VIDAA platform with in silico indices allowed to identify the LAAO configurations associated to a lower risk of thrombus formation; device positioning was key to the creation of regions with turbulent flows after implantation. Our results demonstrate the potential for optimizing LAAO therapy settings during pre-implant planning based on modeling tools and contribute to reduce the risk of thrombus formation after treatment.
• dc.description.sponsorship This work was supported by the Spanish Ministry of Economy and Competitiveness under the Maria de Maeztu Units of Excellence Programme (MDM-2015-0502) and the Retos I+D Programme (DPI2015-71640-R).
• dc.format.mimetype application/pdf
• dc.identifier.citation Aguado AM, Olivares AL, Yagüe C, Silva E, Nuñez-García M, Fernandez-Quilez Á, Mill J, Genua I, Arzamendi D, De Potter T, Freixa X, Camara O. In silico optimization of left a trial appendage occluder implantation using interactive and modeling tools. Front. Physiol. 2019 Mar 22;10:237. DOI: 10.3389/fphys.2019.00237
• dc.identifier.doi http://dx.doi.org/10.3389/fphys.2019.00237
• dc.identifier.issn 1664-042X
• dc.identifier.uri http://hdl.handle.net/10230/37034
• dc.language.iso eng
• dc.publisher Frontiers
• dc.relation.ispartof Frontiers in Physiology. 2019 Mar 22;10:237
• dc.relation.projectID info:eu-repo/grantAgreement/ES/1PE/DPI2015-71640-R
• dc.rights © 2019 Aguado, Olivares, Yagüe, Silva, Nuñez-García, Fernandez-Quilez, Mill, Genua, Arzamendi, De Potter, Freixa and Camara. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri https://creativecommons.org/licenses/by/4.0/deed.ca
• dc.subject.keyword Left atrial appendage occlusion
• dc.subject.keyword Computational fluid dynamics
• dc.subject.keyword In silico optimization of therapies
• dc.subject.keyword Web-based implantation platform
• dc.subject.keyword Atrial fibrillation
• dc.title In silico optimization of left a trial appendage occluder implantation using interactive and modeling tools
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion