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

Area of Science:

• Cardiovascular Medicine
• Biomedical Engineering
• Medical Imaging

Background:

• Device-related thrombosis (DRT) complicates up to 4% of left atrial appendage occlusion (LAAO) procedures.
• The exact causes, predictors, and optimal treatments for DRT remain unclear, necessitating further research.

Purpose of the Study:

• To investigate the correlation between hemodynamic factors and the occurrence of DRT following LAAO.
• To identify specific flow dynamics that may predict DRT risk in patients undergoing LAAO.

Main Methods:

• Utilized a multicenter registry of patients who underwent LAAO with pre- and post-procedure CT imaging.
• Created patient-specific 3D models of the left atrium for finite element and computational fluid dynamics (CFD) simulations.
• Quantified hemodynamic parameters: time-averaged wall shear stress, oscillatory shear index, and endothelial cell activation potential.

Main Results:

• Compared 19 patients with DRT to 19 without, finding larger left atrium volumes and mitral valve areas in the DRT group.
• Patients with DRT exhibited significantly lower time-averaged wall shear stress and higher oscillatory shear index and endothelial cell activation potential (P < 0.001).
• In-vivo thrombus locations correlated well with CFD-derived flow dynamic parameters.

Conclusions:

• Hemodynamic parameters derived from CFD simulations show potential for predicting DRT risk after LAAO.
• Further large-scale studies with long-term follow-up are required to validate CFD's role in risk stratification for LAAO patients.