FEops HEARTguide Patient-Specific Computational Simulations for WATCHMAN FLX Left Atrial Appendage Closure

Figures

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  Central Illustration. FEops HEARTguide Platform Workflow and Prediction Results (A) The preprocedural cardiac computed tomography angiography (CCTA) is uploaded to the web-based platform. The received images are further processed using Mimics. (B) Several different trajectories are modeled to access the appendage as coaxial as possible with the centerline of the left atrial appendage. (C) As output, several options in terms of device size and position are provided in addition to left atrial appendage apposition plots, deformation visualization, and device measurements. (D) FEops modeling resulted in accurate prediction of the final device measurements when compared to intraprocedural 3D transesophageal echocardiography (TEE).

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  Figure 1. Study Design This was a retrospective study that included patients who had a WATCHMAN FLX left atrial appendage closure device implanted and preprocedural cardiac computed tomography angiography (CCTA) and intraprocedural transesophageal echocardiography (TEE) images available. These data were compared to the FEops computational simulation results. CT = computed tomography.

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  Figure 2. Representative Case Example (A) The FEops model predicted a size 31-mm device with proximal positioning, and this was ultimately the device size that was chosen. (B) Intraprocedural 3-dimensional transesophageal echocardiography (TEE) demonstrated the final device position to be similar to the FEops predicted model. No peridevice leak was visualized on the intraprocedural TEE. (C) The 45-day cardiac computed tomography angiography (CCTA) also demonstrated the final device position to be similar to the FEops-predicted model. The residual contrast opacification visualized inside the device on CCTA indicates incomplete endothelialization.

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  Figure 3. Linear Regression Analysis Between the Predicted vs Observed TEE Device Measurements in the Blinded FEops Model (N = 16) (A) Area-based diameter. (B) Perimeter-based diameter. (C) Minimum diameter. (D) Maximum diameter. TEE = transesophageal echocardiography.

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  Figure 4. Bland-Altman Plots for Postimplant Device Diameters: Intraprocedural 3D-TEE and FEops Blinded Stimulation Results (A) Area-based diameter (P = 0.06). (B) Perimeter-based diameter (P = 0.08). (C) Minimum diameter (P = 0.04). (D) Maximum diameter (P = 0.11). The solid purple line represents mean bias; the solid red lines represent the limits of agreement. LOA = limits of agreement; TEE = transesophageal echocardiography.