Left atrial appendage occlusion: On the need of a numerical model to simulate the implant procedure.
finite element analysis
in-silico modeling
left appendix
non-valvular atrial fibrillation
percutaneous closure
watchman FLX device
Journal
International journal for numerical methods in biomedical engineering
ISSN: 2040-7947
Titre abrégé: Int J Numer Method Biomed Eng
Pays: England
ID NLM: 101530293
Informations de publication
Date de publication:
19 Mar 2024
19 Mar 2024
Historique:
revised:
23
01
2024
received:
13
10
2023
accepted:
10
03
2024
medline:
20
3
2024
pubmed:
20
3
2024
entrez:
20
3
2024
Statut:
aheadofprint
Résumé
Left atrial appendage occlusion (LAAO) is a percutaneous procedure to prevent thromboembolism in patients affected by atrial fibrillation. Despite its demonstrated efficacy, the LAA morphological complexity hinders the procedure, resulting in postprocedural drawbacks (device-related thrombus and peri-device leakage). Local anatomical features may cause difficulties in the device's positioning and affect the effectiveness of the device's implant. The current work proposes a detailed FE model of the LAAO useful to investigate implant scenarios and derive clinical indications. A high-fidelity model of the Watchman FLX device and simplified parametric conduits mimicking the zone of the LAA where the device is deployed were developed. Device-conduit interactions were evaluated by looking at clinical indicators such as device-wall gap, possible cause of leakage, and device protrusion. As expected, the positioning of the crimped device before the deployment was found to significantly affect the implant outcomes: clinician's choices can be improved if FE models are used to optimize the pre-operative planning. Remarkably, also the wall mechanical stiffness plays an important role. However, this parameter value is unknown for a specific LAA, a crucial point that must be correctly defined for developing an accurate FE model. Finally, numerical simulations outlined how the device's configuration on which the clinician relies to assess the implant success (i.e., the deployed configuration with the device still attached to the catheter) may differ from the actual final device's configuration, relevant for achieving a safe intervention.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e3814Subventions
Organisme : Ministero della Salute
Organisme : Italian Ministry of Health
ID : RF-2021-12375208
Informations de copyright
© 2024 John Wiley & Sons Ltd.
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