Left atrial appendage occlusion (LAAO) is a percutaneous procedure to prevent thromboembolism in patients affected by atrial fibrillation. Despite its demonstrated efficacy, the LAA morphological complexity hinders the procedure, resulting in postprocedural drawbacks (device‐related thrombus and peri‐device leakage). Local anatomical features may cause difficulties in the device's positioning and affect the effectiveness of the device's implant. The current work proposes a detailed FE model of the LAAO useful to investigate implant scenarios and derive clinical indications. A high‐fidelity model of the Watchman FLX device and simplified parametric conduits mimicking the zone of the LAA where the device is deployed were developed. Device‐conduit interactions were evaluated by looking at clinical indicators such as device‐wall gap, possible cause of leakage, and device protrusion. As expected, the positioning of the crimped device before the deployment was found to significantly affect the implant outcomes: clinician's choices can be improved if FE models are used to optimize the pre‐operative planning. Remarkably, also the wall mechanical stiffness plays an important role. However, this parameter value is unknown for a specific LAA, a crucial point that must be correctly defined for developing an accurate FE model. Finally, numerical simulations outlined how the device's configuration on which the clinician relies to assess the implant success (i.e., the deployed configuration with the device still attached to the catheter) may differ from the actual final device's configuration, relevant for achieving a safe intervention.

中文翻译：

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左心耳封堵：需要一个数值模型来模拟植入过程

左心耳封堵术（LAAO）是一种经皮手术，用于预防房颤患者发生血栓栓塞。尽管其已被证明有效，但左心耳形态的复杂性阻碍了手术，导致术后缺陷（设备相关的血栓和设备周围渗漏）。局部解剖特征可能会导致装置定位困难并影响装置植入物的有效性。目前的工作提出了一个详细的 LAAO 有限元模型，可用于研究植入场景并得出临床适应症。开发了 Watchman FLX 设备的高保真模型和模仿左心耳部署该设备的区域的简化参数导管。通过观察装置壁间隙、可能的泄漏原因和装置突出等临床指标来评估装置与导管的相互作用。正如预期的那样，发现压接装置在部署前的定位会显着影响种植体结果：如果使用有限元模型来优化术前规划，则可以改善临床医生的选择。值得注意的是，壁的机械刚度也起着重要作用。然而，对于特定的左心耳来说，这个参数值是未知的，这是开发精确有限元模型时必须正确定义的关键点。最后，数值模拟概述了临床医生评估植入成功与否的设备配置（即设备仍连接至导管的部署配置）可能与实际的最终设备配置有何不同，这与实现安全干预相关。