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. 2024 Oct 15;3(11):101339.
doi: 10.1016/j.jacadv.2024.101339. eCollection 2024 Nov.

Flow Dynamic Factors Correlated With Device-Related Thrombosis After Left Atrial Appendage Occlusion

Brennan J Vogl  1 , Emily Vitale  1 , Sunyoung Ahn  1 , Agata Sularz  2 , Alejandra Chavez Ponce  2 , Gerardo V Lo Russo  2 , Jeremy Collins  3 , Alessandra Maria Bavo  4 , Ahmed El Shaer  2 , Anders Kramer  5 , Yuheng Jia  6 , Davorka Lulic  6 , Matthieu De Beule  4 , Jens Erik Nielsen-Kudsk  5 , Ole De Backer  6 , Mohamad Alkhouli  2 , Hoda Hatoum  1   7
Affiliations

Flow Dynamic Factors Correlated With Device-Related Thrombosis After Left Atrial Appendage Occlusion

Brennan J Vogl et al. JACC Adv. .

Abstract

Background: Device-related thrombosis (DRT) occurs in up to 4% of patients undergoing left atrial appendage occlusion (LAAO) and is associated with substantial morbidity and mortality. However, its pathophysiology, predictors, and optimal management remain unclear.

Objectives: This study aims to assess flow dynamic factors correlating to DRT.

Methods: A multicenter registry of patients who underwent LAAO and had pre- and post-computed tomography imaging was used. Patient-specific 3-dimensional digital models of the left atrium were created, and finite element simulations were performed to implant an LAAO device into each model in a position that matched the clinical deployment. Computational fluid dynamic simulations were performed to quantify the following flow dynamic parameters: time averaged wall shear stress, oscillatory shear index, and endothelial cell activation potential.

Results: A total of 38 patients (19 with DRT and 19 without DRT) were included. Left atrium volumes and mitral valve areas were larger in the DRT cohort compared with controls. Patients with DRT had a significantly lower time averaged wall shear stress (1.76 ± 1.24 Pa vs 2.90 ± 2.70 Pa), a higher oscillatory shear index (0.19 ± 0.11 vs 0.17 ± 0.11), and a higher endothelial cell activation potential (0.23 ± 0.58 Pa-1 vs 0.17 ± 0.30 Pa-1) than the controls (P < 0.001 for all). Thrombus locations identified from in-vivo images correlated well with the flow dynamic parameters tested.

Conclusions: Flow dynamic parameters may be able to predict the risk of DRT after LAAO. Further investigation with a larger patient cohort and long-term follow-up is needed to assess the role of computational fluid dynamics in the risk stratification of patients considered for LAAO.

Keywords: DRT; LAAO; device-related thrombosis; left atrial appendage occlusion; thrombosis.

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Conflict of interest statement

This research was partly supported by the American Heart Association (AHA) under award number 24CDA1269661. Dr De Backer has received consulting fees and institutional research grants from 10.13039/100000046Abbott and 10.13039/100008497Boston Scientific. Dr Nielsen-Kudsk has received institutional research grants from 10.13039/100000046Abbott, 10.13039/100008497Boston Scientific, and the 10.13039/501100009708Novo Nordic Foundation. Dr Bavo is an employee of FEops. Dr De Beule is a shareholder of FEops. Dr Vogl was partially supported by the 10.13039/100001502Blue Cross Blue Shield of Michigan Foundation, the DeVlieg Foundation, and the Health Research Institute fellowship at Michigan Tech. Dr Jia has received a scholarship from China Scholarship Council under the State Scholarship Fund of China. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Workflow Adopted for This Study, Utilizing a Sequence of Finite Element Analysis and Computational Fluid Dynamics CT = computed tomography; ECAP = endothelial cell activation potential; OSI = oscillatory shear index; TAWSS = time averaged wall shear stress; TTE = transthoracic echocardiogram.
Figure 2
Figure 2
Sample of TAWSS, OSI, and ECAP Contours for the Top Surface of Each Device for the DRT and CTL Populations Sample of time averaged wall shear stress (A), oscillatory shear index (B), and endothelial cell activation potential (C) contours for the top surface of each device for the device-related thrombosis, and control populations. Thrombus locations from in-vivo imaging are shown by the black line for each drt patient displayed. The line represents the border of the thrombus. DRT = device-related thrombosis; CTL = control; other abbreviations as in Figure 1.
Central Illustration
Central Illustration
Flow Dynamic Factors Correlated With Device-Related Thrombosis After Left Atrial Appendage Occlusion Patient-specific modeling (A) of the left atrium and left atrial appendage occlusion devices for use in a combined finite element and computational fluid dynamics simulations (B) to identify fluid dynamics predictors of device related thrombosis (DRT). (C) Patients with DRT had lower time averaged wall shear stress, high oscillatory shear index, and high endothelial cell activation potential, indicating an increased likelihood of thrombosis. ECAP = endothelial cell activation potential; OSI = oscillatory shear index; TAWSS = time averaged wall shear stress; abbreviations as in Figures 1 and 2.
See this image and copyright information in PMC

References

    1. Kornej J., Börschel C.S., Benjamin E.J., Schnabel R.B. Epidemiology of atrial fibrillation in the 21st century: novel methods and new insights. Circ Res. 2020;127:4–20. - PMC - PubMed
    1. Reddy V.Y., Doshi S.K., Kar S., et al. 5-year outcomes after left atrial appendage closure: from the PREVAIL and PROTECT AF trials. J Am Coll Cardiol. 2017;70:2964–2975. - PubMed
    1. Alkhouli M., Ellis C.R., Daniels M., Coylewright M., Nielsen-Kudsk J.E., Holmes D.R. Left atrial appendage occlusion: current advances and remaining challenges. JACC Adv. 2022 - PMC - PubMed
    1. Holmes D.R., Jr., Alkhouli M., Reddy V. Left atrial appendage occlusion for the unmet clinical needs of stroke prevention in nonvalvular atrial fibrillation. Mayo Clin Proc. 2019;94:864–874. - PubMed
    1. Alkhouli M., Alqahtani F., Aljohani S., Alvi M., Holmes D.R. Burden of atrial fibrillation–associated ischemic stroke in the United States. JACC Clin Electrophysiol. 2018;4:618–625. - PubMed

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