Left atrial appendage occlusion: On the need of a numerical model to simulate the implant procedure

IF 2.2 4区 医学 Q3 ENGINEERING, BIOMEDICAL International Journal for Numerical Methods in Biomedical Engineering Pub Date : 2024-03-19 DOI:10.1002/cnm.3814
Francesca Danielli, Francesca Berti, Benigno Marco Fanni, Emanuele Gasparotti, Simona Celi, Giancarlo Pennati, Lorenza Petrini
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Abstract

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.

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左心房阑尾闭塞:模拟植入过程的数字模型的必要性。
左心房阑尾闭塞术(LAAO)是一种经皮手术,用于预防心房颤动患者的血栓栓塞。尽管疗效显著,但 LAA 形态的复杂性阻碍了手术的进行,导致术后出现各种弊端(与装置相关的血栓和装置周围渗漏)。局部解剖特征可能会导致装置定位困难,影响装置植入的效果。目前的工作提出了一个详细的 LAAO FE 模型,该模型有助于研究植入情况并得出临床适应症。我们开发了 Watchman FLX 设备的高保真模型和简化的参数导管,以模拟 LAA 设备部署区域。通过观察器械壁间隙、可能的泄漏原因和器械突出等临床指标,评估了器械与导管之间的相互作用。正如预期的那样,研究发现在植入前卷曲装置的定位对植入效果有显著影响:如果使用 FE 模型来优化术前规划,临床医生的选择就能得到改善。值得注意的是,壁的机械刚度也起着重要作用。然而,对于特定的 LAA 而言,这一参数值是未知的,这是开发精确的 FE 模型必须正确定义的关键点。最后,数值模拟概述了临床医生评估植入成功与否所依赖的设备配置(即设备仍连接在导管上的部署配置)与实际最终设备配置之间的差异,这与实现安全干预息息相关。
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来源期刊
International Journal for Numerical Methods in Biomedical Engineering
International Journal for Numerical Methods in Biomedical Engineering ENGINEERING, BIOMEDICAL-MATHEMATICAL & COMPUTATIONAL BIOLOGY
CiteScore
4.50
自引率
9.50%
发文量
103
审稿时长
3 months
期刊介绍: All differential equation based models for biomedical applications and their novel solutions (using either established numerical methods such as finite difference, finite element and finite volume methods or new numerical methods) are within the scope of this journal. Manuscripts with experimental and analytical themes are also welcome if a component of the paper deals with numerical methods. Special cases that may not involve differential equations such as image processing, meshing and artificial intelligence are within the scope. Any research that is broadly linked to the wellbeing of the human body, either directly or indirectly, is also within the scope of this journal.
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