10.3389/fphys.2019.00237.s005 Ainhoa M. Aguado Ainhoa M. Aguado Andy L. Olivares Andy L. Olivares Carlos Yagüe Carlos Yagüe Etelvino Silva Etelvino Silva Marta Nuñez-García Marta Nuñez-García Álvaro Fernandez-Quilez Álvaro Fernandez-Quilez Jordi Mill Jordi Mill Ibai Genua Ibai Genua Dabit Arzamendi Dabit Arzamendi Tom De Potter Tom De Potter Xavier Freixa Xavier Freixa Oscar Camara Oscar Camara Video_4_In silico Optimization of Left Atrial Appendage Occluder Implantation Using Interactive and Modeling Tools.mp4 Frontiers 2019 left atrial appendage occlusion Computational Fluid Dynamics in silico optimization of therapies web-based implantation platform atrial fibrillation 2019-03-22 13:41:09 Media https://frontiersin.figshare.com/articles/media/Video_4_In_silico_Optimization_of_Left_Atrial_Appendage_Occluder_Implantation_Using_Interactive_and_Modeling_Tools_mp4/7880639 <p>According to clinical studies, around one third of patients with atrial fibrillation (AF) will suffer a stroke during their lifetime. Between 70 and 90% of these strokes are caused by thrombus formed in the left atrial appendage. In patients with contraindications to oral anticoagulants, a left atrial appendage occluder (LAAO) is often implanted to prevent blood flow entering in the LAA. A limited range of LAAO devices is available, with different designs and sizes. Together with the heterogeneity of LAA morphology, these factors make LAAO success dependent on clinician's experience. A sub-optimal LAAO implantation can generate thrombi outside the device, eventually leading to stroke if not treated. The aim of this study was to develop clinician-friendly tools based on biophysical models to optimize LAAO device therapies. A web-based 3D interactive virtual implantation platform, so-called VIDAA, was created to select the most appropriate LAAO configurations (type of device, size, landing zone) for a given patient-specific LAA morphology. An initial LAAO configuration is proposed in VIDAA, automatically computed from LAA shape features (centreline, diameters). The most promising LAAO settings and LAA geometries were exported from VIDAA to build volumetric meshes and run Computational Fluid Dynamics (CFD) simulations to assess blood flow patterns after implantation. Risk of thrombus formation was estimated from the simulated hemodynamics with an index combining information from blood flow velocity and complexity. The combination of the VIDAA platform with in silico indices allowed to identify the LAAO configurations associated to a lower risk of thrombus formation; device positioning was key to the creation of regions with turbulent flows after implantation. Our results demonstrate the potential for optimizing LAAO therapy settings during pre-implant planning based on modeling tools and contribute to reduce the risk of thrombus formation after treatment.</p>