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In silico optimization of left atrial appendage Occluder implantation using interactive and modeling tools
Aguado, Ainhoa M. (Universitat Pompeu Fabra. Departament de Tecnologies de la Informació i les Comunicacions)
Olivares, Andy Luis (Universitat Pompeu Fabra. Departament de Tecnologies de la Informació i les Comunicacions)
Yaguë, Carlos (Universitat Pompeu Fabra. Departament de Tecnologies de la Informació i les Comunicacions)
Silva Garcia, Etelvino (Institut d'Investigació Biomèdica Sant Pau)
Nuñez-Garcia, Marta (Universitat Pompeu Fabra. Departament de Tecnologies de la Informació i les Comunicacions)
Fernandez-Quilez, Alvaro (Universitat Pompeu Fabra. Departament de Tecnologies de la Informació i les Comunicacions)
Mill, Jordi (Universitat Pompeu Fabra. Departament de Tecnologies de la Informació i les Comunicacions)
Genua, Ibai (Universitat Pompeu Fabra. Departament de Tecnologies de la Informació i les Comunicacions)
Arzamendi, Dabit (Institut d'Investigació Biomèdica Sant Pau)
de Potter, Tom (Arrhythmia Unit. Department of Cardiology. Cardiovascular Center)
Freixa, Xavier (Hospital Clínic i Provincial de Barcelona)
Camara, Oscar (Universitat Pompeu Fabra. Departament de Tecnologies de la Informació i les Comunicacions)
Universitat Autònoma de Barcelona

Date: 2019
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.
Grants: Ministerio de Economía y Competitividad MDM-2015-0502
Note: Altres ajuts: This work was supported by the Retos I+D Programme (DPI2015-71640-R).
Rights: Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original. Creative Commons
Language: Anglès
Document: Article ; recerca ; Versió publicada
Subject: Computational Fluid Dynamics ; Atrial fibrillation ; In silico optimization of therapies ; Left atrial appendage occlusion ; Web-based implantation platform
Published in: Frontiers in physiology, Vol. 10 Núm. MAR (2019) , p. 237, ISSN 1664-042X

DOI: 10.3389/fphys.2019.00237
PMID: 30967786


13 p, 3.2 MB

The record appears in these collections:
Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut de Recerca Sant Pau
Articles > Research articles
Articles > Published articles

 Record created 2020-06-03, last modified 2023-11-29



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