Impact of occluder device configurations in in-silico left atrial hemodynamics for the analysis of device-related thrombus

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  • dc.contributor.author Albors, Carlos
  • dc.contributor.author Mill, Jordi
  • dc.contributor.author Olivares Miyares, Andy Luis
  • dc.contributor.author Iriart, Xavier
  • dc.contributor.author Cochet, Hubert
  • dc.contributor.author Camara, Oscar
  • dc.date.accessioned 2025-06-20T08:36:30Z
  • dc.date.available 2025-06-20T08:36:30Z
  • dc.date.issued 2024
  • dc.description.abstract Left atrial appendage occlusion devices (LAAO) are a feasible alternative for non-valvular atrial fibrillation (AF) patients at high risk of thromboembolic stroke and contraindication to antithrombotic therapies. However, optimal LAAO device configurations (i.e., size, type, location) remain unstandardized due to the large anatomical variability of the left atrial appendage (LAA) morphology, leading to a 4-6% incidence of device-related thrombus (DRT). In-silico simulations have the potential to assess DRT risk and identify the key factors, such as suboptimal device positioning. This work presents fluid simulation results computed on 20 patient-specific left atrial geometries, analysing different commercially available LAAO occluders, including plug-type and pacifier-type devices. In addition, we explored two distinct device positions: 1) the real post-LAAO intervention configuration derived from follow-up imaging; and 2) one covering the pulmonary ridge if it was not achieved during the implantation (13 out of 20). In total, 33 different configurations were analysed. In-silico indices indicating high risk of DRT (e.g., low blood flow velocities and flow complexity around the device) were combined with particle deposition analysis based on a discrete phase model. The obtained results revealed that covering the pulmonary ridge with the LAAO device may be one of the key factors to prevent DRT, resulting in higher velocities and reduced flow recirculations (e.g., mean velocities of 0.183 ± 0.12 m/s and 0.236 ± 0.16 m/s for uncovered versus covered positions in DRT patients). Moreover, disk-based devices exhibited enhanced adaptability to various LAA morphologies and, generally, demonstrated a lower risk of abnormal events after LAAO implantation.
  • dc.description.sponsorship This work was supported by the European Union’s Horizon 2020 research and innovation program SimCardioTest (101016496 to OC), by the programm GEMINI (GA 101136438), and by the Spanish Ministry of Science, Innovation and Universities under the GENERALITAAT, (PID2022-143239OB-I00 to OC). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
  • dc.format.mimetype application/pdf
  • dc.identifier.citation Albors C, Mill J, Olivares AL, Iriart X, Cochet H, Camara O. Impact of occluder device configurations in in-silico left atrial hemodynamics for the analysis of device-related thrombus. PLoS Comput Biol. 2024;20(9):e1011546. DOI: 10.1371/journal.pcbi.1011546
  • dc.identifier.doi http://dx.doi.org/10.1371/journal.pcbi.1011546
  • dc.identifier.issn 1553-734X
  • dc.identifier.uri http://hdl.handle.net/10230/70739
  • dc.language.iso eng
  • dc.publisher Public Library of Science (PLoS)
  • dc.relation.ispartof PLoS Computational Biology. 2024;20(9):e1011546
  • dc.relation.projectID info:eu-repo/grantAgreement/EC/H2020/101016496
  • dc.relation.projectID info:eu-repo/grantAgreement/EC/HE/101136438
  • dc.relation.projectID info:eu-repo/grantAgreement/ES/3PE/PID2022-143239OB-I00
  • dc.rights © 2024 Albors et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
  • dc.rights.accessRights info:eu-repo/semantics/openAccess
  • dc.rights.uri http://creativecommons.org/licenses/by/4.0/
  • dc.subject.other Hemodinàmica
  • dc.subject.other Trombosi
  • dc.subject.other Oclusions arterials
  • dc.title Impact of occluder device configurations in in-silico left atrial hemodynamics for the analysis of device-related thrombus
  • dc.type info:eu-repo/semantics/article
  • dc.type.version info:eu-repo/semantics/publishedVersion

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