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

Brennan J. Vogl, BS; Emily Vitale, BS; Sunyoung Ahn, MS; Agata Sularz, MB BChir; Alejandra Chavez Ponce, MD; Gerardo V. Lo Russo, MD; Jeremy Collins, MD; Alessandra Maria Bavo, PhD; Ahmed El Shaer, MD; Anders Kramer, MD; Yuheng Jia, MD; Davorka Lulic, MD; Matthieu De Beule, PhD; Jens Erik Nielsen-Kudsk, MD; Ole De Backer, MD; Mohamad Alkhouli, MD; Hoda Hatoum, PhD

JACC: Advances (Nov 2024)

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

Brennan J. Vogl, BS,
Emily Vitale, BS,
Sunyoung Ahn, MS,
Agata Sularz, MB BChir,
Alejandra Chavez Ponce, MD,
Gerardo V. Lo Russo, MD,
Jeremy Collins, MD,
Alessandra Maria Bavo, PhD,
Ahmed El Shaer, MD,
Anders Kramer, MD,
Yuheng Jia, MD,
Davorka Lulic, MD,
Matthieu De Beule, PhD,
Jens Erik Nielsen-Kudsk, MD,
Ole De Backer, MD,
Mohamad Alkhouli, MD,
Hoda Hatoum, PhD

Affiliations

Brennan J. Vogl, BS: Department of Biomedical Engineering, Michigan Technological University, Houghton, Michigan, USA
Emily Vitale, BS: Department of Biomedical Engineering, Michigan Technological University, Houghton, Michigan, USA
Sunyoung Ahn, MS: Department of Biomedical Engineering, Michigan Technological University, Houghton, Michigan, USA
Agata Sularz, MB BChir: Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
Alejandra Chavez Ponce, MD: Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
Gerardo V. Lo Russo, MD: Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
Jeremy Collins, MD: Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
Alessandra Maria Bavo, PhD: FEops NV, Gent, Belgium
Ahmed El Shaer, MD: Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
Anders Kramer, MD: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
Yuheng Jia, MD: Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
Davorka Lulic, MD: Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
Matthieu De Beule, PhD: FEops NV, Gent, Belgium
Jens Erik Nielsen-Kudsk, MD: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
Ole De Backer, MD: Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
Mohamad Alkhouli, MD: Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA; Dr Mohamad Alkhouli, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA.
Hoda Hatoum, PhD: Department of Biomedical Engineering, Michigan Technological University, Houghton, Michigan, USA; Health Research Institute, Center of Biocomputing and Digital Health and Institute of Computing and Cybersystems, Michigan Technological University, Houghton, Michigan, USA; Address for correspondence: Prof Hoda Hatoum, Michigan Technological University, Department of Biomedical Engineering, 1400 Townsend Dr, Houghton, Michigan 49931, USA.

Journal volume & issue: Vol. 3, no. 11
p. 101339

Abstract

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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.

Published in JACC: Advances

ISSN: 2772-963X (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system; Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://www.sciencedirect.com/journal/jacc-advances

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