Key result
Customized, patient-specific left atrial appendage occlusion using advanced imaging and computational modeling represents a paradigm shift to resolve device-anatomy mismatch.
Why the study?
Current percutaneous LAA occlusion devices are limited by device-anatomy mismatch due to interpatient heterogeneity, leading to risks such as peri-implant leakage and device-related thrombosis.
Advances in imaging, computational modeling, and 3D printing are enabling a shift toward customized, patient-specific approaches for left atrial appendage occlusion to reduce device-anatomy mismatch.
The left atrial appendage (LAA) is a complex structure with unknown physiologic function protruding from the main body of the left atrium. In patients with atrial fibrillation, the left atrium does not contract effectively. Insufficient atrial and LAA contractility predisposes the LAA morphology to hemostasis and thrombus formation, leading to an increased risk of cardioembolic events. Oral anticoagulation therapies are the mainstay of stroke prevention options for patients; however, not all patients are candidates for long-term oral anticoagulation. Percutaneous occlusion devices are an attractive alternative to long-term anticoagulation therapy, although they are not without limitations, such as peri-implant leakage and device-related thrombosis. Although efforts have been made to reduce these risks, significant interpatient heterogeneity inevitably yields some degree of device-anatomy mismatch that is difficult to resolve using current devices and can ultimately lead to insufficient occlusion and poor patient outcomes. In this state-of-the-art review, we evaluated the anatomy of the LAA as well as the current pathophysiologic understanding and stroke prevention strategies used in the management of the risk of stroke associated with atrial fibrillation. We highlighted recent advances in computed tomography imaging, preprocedural planning, computational modeling, and novel additive manufacturing techniques, which represent the tools needed for a paradigm shift toward patient-centric LAA occlusion. Together, we envisage that these techniques will facilitate a pipeline from the imaging of patient anatomy to patient-specific computational and bench-top models that enable customized, data-driven approaches for LAA occlusion that are engineered specifically to meet each patient's unique needs.
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Mendez et al. (2022) conducted a review in Atrial fibrillation. Left atrial appendage occlusion was evaluated. Customized, patient-specific left atrial appendage occlusion using advanced imaging and computational modeling represents a paradigm shift to resolve device-anatomy mismatch.
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