In silico optimization of left atrial appendage occluder implantation using interactive and modelling tools

• A. M. Aguado ^[1] ; A. L. Olivares ^[1] ; C. Yagüe ^[1] ; E. Silva ^[3] ; M. Nuñez-García ^[1] ; A. Fernández ^[1] ; J. Mill ^[1] ; I. Genua ^[1] ; T. de Potter ^[3] ; X. Freixa ^[2] ; O. Camara ^[1]
  1. [1] Universitat Pompeu Fabra

     Universitat Pompeu Fabra

     Barcelona, España

     
  2. [2] Universitat de Barcelona

     Universitat de Barcelona

     Barcelona, España

     
  3. [3] Arrhythmia Unit, Department of Cardiology, Cardiovascular Center, Aaalst, Belgium

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• Localización: Libro de Actas del XXXVI Congreso Anual de la Sociedad Española de Ingeniería Biomédica / Ma Gloria Bueno García (dir.), 2018, ISBN 978-84-09-06253-9, págs. 299-302
• Idioma: inglés
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• Resumen

  • Around 90% of strokes in patients with Atrial Fibrillation (AF) are caused by a thrombus formed in the left atrial appendage (LAA). Oral anticoagulant (OAC) administration is the first line of treatment for stroke prevention in AF patients. In patients with contraindications to OAC, a left atrial appendage occluder (LAAO) is implanted to prevent blood flow entering in the LAA. A limited range of LAAO devices are available, with different designs and sizes. Together with the heterogeneity of LAA morphology, these factors make LAAO implantation strongly dependent on clinician's experience. A sub-optimal LAAO implantation can induce thrombi generation outside the LAA, eventually leading to stroke if not treated. The aim of this study was to develop clinician friendly tools to optimize LAAO-based therapies. A web-based virtual implantation application was developed, VIDAA, to allow clinicians to select the most appropriate LAAO. Computational Fluid Dynamics (CFD) simulations were then run to estimate thrombus formation risk. Morphological meshes from patient-specific medical images were generated. LAAO meshes were built in Computer Aided Design (CAD). Several device configurations were virtually implanted with the developed platform. Blood flow dynamics were modelled with CFD, imposing as boundary conditions the inlet velocity in the pulmonary veins and a changeable condition at the mitral valve. From the developed application, the device configuration automatically obtained was the one presenting the best rates of LAA closure. Results obtained suggested that device configuration could reduce a 75% thrombus formation, making pre-implant evaluation crucial for obtaining the best clinical outcomes.