Journal Article Multicenter Study Epublish
PubMed: 42003302 DOI: 10.4244/EIJ-D-25-01328
Impact of device implantation depth on blood flow dynamics after left atrial appendage closure.
EuroIntervention 22(8):e444-e454
Authors: Pedro Cepas-Guillén, Carlos Albors, Jordi Mill, Adel Aminian, Philippe Garot, Ole De Backer, Jens Erik Nielsen-Kudsk, Xavier Iriart, Manuel Barreiro-Perez, Eduardo Flores-Umanzor, Ignacio Cruz-González, Dabit Arzamendi, Marisa Avvedimento, Luis Nombela-Franco, Nina Leduc, Jérôme Horvilleur, Klaus Fuglsang Kofoed, Kasper Korsholm, Hubert Cochet, Rodrigo Estevez-Loureiro, Manal Barrouhou, Ana Lafond, Xavi Millán, Laura Sanchis, Josep Rodés-Cabau, Oscar Camara, Xavier Freixa
Affiliations
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic Barcelona, IDIBAPS, Barcelona, Spain.
- Department of Engineering, Physense, BCN MedTech, Universitat Pompeu Fabra, Barcelona, Spain.
- Cardiology Department, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium.
- Institut Cardiovasculaire Paris-Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France.
- Cardiology Department, Rigshospitalet, Copenhagen, Denmark.
- Cardiology Department, Aarhus University Hospital, Aarhus, Denmark.
- Department of Fetal, Pediatric and Adult Congenital Cardiology, M3C National CHD Reference Centre, Bordeaux University Hospital, Haut-Lévêque Hospital, Pessac, France and IHU Liryc, INSERM 1045, University of Bordeaux, Pessac, France.
- Cardiology Department, University Hospital Álvaro Cunqueiro, Vigo, Spain and Cardiovascular Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain.
- Cardiology Department, Hospital Universitario de Salamanca, IBSAL, CIBER-CV, Salamanca, Spain.
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec, Canada.
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain.
Abstract
BACKGROUND
Device-related thrombus (DRT) remains a concern after left atrial appendage closure (LAAC), particularly when the device is deeply implanted. However, the mechanistic links between implantation depth, flow dynamics, and DRT risk are not well understood.
AIMS
We therefore aimed to evaluate the impact of LAAC device implantation depth on local flow characteristics and its association with DRT using patient-specific computational fluid dynamics (CFD).
METHODS
The study included 285 patients undergoing LAAC with either Amplatzer Amulet or WATCHMAN devices at 10 centres. Patient-specific CFD simulations were performed using postprocedural computed tomography and echocardiography-derived boundary conditions to assess blood flow dynamics. The primary endpoint was the comparison of CFD-derived flow indices - device surface velocity index (DSVI), endothelial cell activation potential (ECAP), and the presence of eddies/stagnated flow - between proximal and distal device implantation groups. Secondary analyses explored the relationship between these flow features and DRT.
RESULTS
Proximal implants (57.2%) showed more favourable flow patterns: higher DSVI (0.11 m/s vs 0.09 m/s; p=0.002), lower ECAP (0.75 vs 0.90; p=0.003), and fewer recirculating zones (40.5% vs 74.6%; p<0.001). DRT incidence increased with greater implantation depth, paralleled by worsening flow indices. A composite CFD-based DRT risk score, incorporating ECAP, implantation depth, and flow complexity, demonstrated good discrimination (area under the receiver operating characteristic curve [AUC] 0.81), outperforming anatomical depth alone (AUC 0.71).
CONCLUSIONS
Deeper LAAC device implantation is associated with adverse flow profiles and a higher risk of DRT. CFD-based flow characterisation may enhance risk stratification beyond anatomical criteria alone. Further studies incorporating clinical variables are warranted to validate these methods.
MeSH
Atrial Appendage, Blood, Cardiac Surgical Procedures, Blood Circulation