Fig 1.
Different designs of percutaneous left atrial appendage devices.
The Watchman and Watchman FLX devices extracted from Boston Scientific Corporation or its affiliates, all rights reserved [5]. The Amplatzer Cardiac Plug (ACP) and Amplatzer Amulet devices extracted from Abbot Corporation or its affiliates, all rights reserved [6]. LAmbre device extracted from Lifetech Scientific Corporation or its affiliates, all rights reserved [7]. Omega device extracted from Eclipse Medical Corporation or its affiliates, all rights reserved [8]. Penditure device extracted from Medtronic Corporation or its affiliates, all rights reserved [9]. AtriClip device extracted from AtriCure Corporation or its affiliates, all rights reserved [10]. LAAO: left atrial appendage occlusion; ACP: Amplatzer Cardiac Plug.
Fig 2.
Definition of uncovered pulmonary ridge (UPR) and covered pulmonary ridge (CPR) regions, depicted in red and green, respectively.
(a) illustrates a deep device implantation resulting in a substantial uncovered ridge area. (b) demonstrates a proximal device placement that covers the pulmonary ridge area.
Table 1.
Characterization of the cohort of 20 patients analysed in terms of clinical outcomes related to control and device-related thrombosis (DRT) subjects, with the device type and size.
The analysis covers the implanted post-left atrial appendage occlusion (LAAO) configuration, as well as the proposed configuration covering the pulmonary ridge (PR). Device types were maintained on the configuration covering the pulmonary ridge. ACP: Amplatzer Cardiac Plug. Config.: configuration. Vol.: volume. PM.: perimeter.
Fig 3.
Modeling pipeline of plug-type and pacifier-type device deployment in the pre-operative left atrial geometry.
A proposed configuration covering the pulmonary ridge (PR) is suggested in the plug-type device. LAAO: Left atrial appendage occlusion; CT: computed tomography. VIDAA: Virtual Implantation and Device selection in left Atrial Appendages.
Fig 4.
Device deployment process of a plug-type device.
(a) Segmented plug-type device (red wireframe) from computed tomography (CT) scans following a left atrial appendage occlusion (LAAO) procedure. (b) LAAO device configuration in a longitudinal LAA cut of the CT scan. (c) Computer-aided design model (blue) of the plug-type device replicating the LAAO configuration extracted from the CT scan. (d) Final device configuration within the LAA cavity.
Fig 5.
Maximum and minimum diagonal measurements of the landing zone planes in the post left atrial appendage occlusion (LAAO) configuration and in the proposed configuration covering the pulmonary ridge for Patients #13 and #17*.
Dmax: Maximum diagonal. Dmin: Minimum diagonal. Dmean: Average diagonal.
Fig 6.
Simulated fluid flow patterns during late systole (t = 0.3 s), early diastole (t = 0.5 s), and late diastole (t = 0.7 s) in the control patient #9 and patient #14* with device-related thrombus (DRT).
The first column depicts the uncovered region of the pulmonary ridge in pink. LAAO: left atrial appendage occlusion. LSPV: left superior pulmonary vein. MV: mitral valve. * indicates patients with DRT.
Table 2.
Averaged (Avg.) velocities (average ± standard deviation) during systolic, diastolic and full cardiac cycle phases on device surface in the cohort of 20 cases.
Mean velocity values of the entire cardiac cycle < 0.2 m/s (highlighted in bold) may indicate high risk of device-related thrombosis (DRT) [55]. LAAO: left atrial appendage occlusion. PR: pulmonary ridge. * defines the patients with DRT.
Table 3.
Peak and mean (average ± standard deviation) values of the endothelial cell activation potential (ECAP) on device surface in the cohort of 20 cases.
ECAP values > 0.5 Pa−1 (highlighted in bold) may indicate high risk of device-related thrombus (DRT). LAAO: left atrial appendage occlusion. PR: pulmonary ridge * defines the patients with DRT.
Fig 7.
Quantification of particle attachment to the left atrial appendage wall at the end of the cardiac cycle in the 20 patients cohort.
Blue represents the post-left atrial appendage occlusion (LAAO) configuration and, red represents the proposed configuration covering the pulmonary ridge. PR: pulmonary ridge. * denotes patients with device-related thrombus (DRT).
Fig 8.
The Discrete Phase Model (DPM) results for the 33 analysed configurations, showing platelet concentration from a frontal visualization of the left atrial appendage (LAA).
Panel (a) represents the real post-left atrial appendage occlusion (LAAO) configuration, while panel (b) shows the proposed configuration covering the pulmonary ridge. * defines the patients with DRT.
Table 4.
In-silico indices obtained in the 20 analysed cases with the two proposed configurations: Post-left atrial appendage occlusion (LAAO) and the proposed configuration covering the PR (pulmonary ridge).
Bold highlights indicate unexpected results. In the implanted post-LAAO configuration of the control group and the proposed configuration covering the pulmonary ridge, a low-risk outcome would be anticipated, where all indices should display NO. Conversely, the DRT group would be expected to exhibit the opposite. ECAP: endothelial cell activation potential * defines the patients with DRT.