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Article

Sensitivity Analysis of In Silico Fluid Simulations to Predict Thrombus Formation after Left Atrial Appendage Occlusion

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BCN-MedTech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, 08018 Barcelona, Spain
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Department of Cardiology, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain
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Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Grupo GADICOR, Hospital Universitario Puerta del Mar, Universidad de Cádiz, 11009 Cádiz, Spain
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Electrophysiology and Heart Modeling Institute (IHU Liryc), 33600 Pessac, France
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Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Université de Bordeaux, 33076 Bordeaux, France
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Department of Cardiology, Hospital Clínic, 08036 Barcelona, Spain
*
Author to whom correspondence should be addressed.
Academic Editors: Rafael Sebastian and Umberto Morbiducci
Mathematics 2021, 9(18), 2304; https://doi.org/10.3390/math9182304
Received: 2 June 2021 / Revised: 8 September 2021 / Accepted: 15 September 2021 / Published: 18 September 2021
Atrial fibrillation (AF) is nowadays the most common human arrhythmia and it is considered a marker of an increased risk of embolic stroke. It is known that 99% of AF-related thrombi are generated in the left atrial appendage (LAA), an anatomical structure located within the left atrium (LA). Left atrial appendage occlusion (LAAO) has become a good alternative for nonvalvular AF patients with contraindications to anticoagulants. However, there is a non-negligible number of device-related thrombus (DRT) events, created next to the device surface. In silico fluid simulations can be a powerful tool to better understand the relation between LA anatomy, haemodynamics, and the process of thrombus formation. Despite the increasing literature in LA fluid modelling, a consensus has not been reached yet in the community on the optimal modelling choices and boundary conditions for generating realistic simulations. In this line, we have performed a sensitivity analysis of several boundary conditions scenarios, varying inlet/outlet and LA wall movement configurations, using patient-specific imaging data of six LAAO patients (three of them with DRT at follow-up). Mesh and cardiac cycle convergence were also analysed. The boundary conditions scenario that better predicted DRT cases had echocardiography-based velocities at the mitral valve outlet, a generic pressure wave from an AF patient at the pulmonary vein inlets, and a dynamic mesh approach for LA wall deformation, emphasizing the need for patient-specific data for realistic simulations. The obtained promising results need to be further validated with larger cohorts, ideally with ground truth data, but they already offer unique insights on thrombogenic risk in the left atria. View Full-Text
Keywords: sensitivity analysis; boundary conditions; computational fluid dynamics; dynamic mesh; device-related thrombus; left atrium; left atrial appendage sensitivity analysis; boundary conditions; computational fluid dynamics; dynamic mesh; device-related thrombus; left atrium; left atrial appendage
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MDPI and ACS Style

Mill, J.; Agudelo, V.; Olivares, A.L.; Pons, M.I.; Silva, E.; Nuñez-Garcia, M.; Morales, X.; Arzamendi, D.; Freixa, X.; Noailly, J.; Camara, O. Sensitivity Analysis of In Silico Fluid Simulations to Predict Thrombus Formation after Left Atrial Appendage Occlusion. Mathematics 2021, 9, 2304. https://doi.org/10.3390/math9182304

AMA Style

Mill J, Agudelo V, Olivares AL, Pons MI, Silva E, Nuñez-Garcia M, Morales X, Arzamendi D, Freixa X, Noailly J, Camara O. Sensitivity Analysis of In Silico Fluid Simulations to Predict Thrombus Formation after Left Atrial Appendage Occlusion. Mathematics. 2021; 9(18):2304. https://doi.org/10.3390/math9182304

Chicago/Turabian Style

Mill, Jordi, Victor Agudelo, Andy L. Olivares, Maria I. Pons, Etelvino Silva, Marta Nuñez-Garcia, Xabier Morales, Dabit Arzamendi, Xavier Freixa, Jérôme Noailly, and Oscar Camara. 2021. "Sensitivity Analysis of In Silico Fluid Simulations to Predict Thrombus Formation after Left Atrial Appendage Occlusion" Mathematics 9, no. 18: 2304. https://doi.org/10.3390/math9182304

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