RESEARCH ARTICLE - APPLICATION
Patient‐specific simulation of guidewire deformation during
transcatheter aortic valve implantation
| Vincent Auffret
| Miguel Castro
| Pierre Badel
| Michel Rochette
| Stéphane Avril
ANSYS France, 69100 Villeurbanne,
Ecole Nationale Supérieure des Mines de
Saint‐Etienne, CIS‐EMSE, INSERM:
U1059, SAINBIOSE, 42023 Saint‐Etienne,
INSERM, U1099, 35000 Rennes, France
LTSI, Université de Rennes 1, 35000
CHU Rennes, Service de Cardiologie et
Maladies Vasculaires, 35000 Rennes,
Pascal Haigron, LTSI, Université de
Rennes 1, campus de Beaulieu bat.22,
35000 Rennes, France.
Transcatheter aortic valve implantation is a recent mini‐invasive procedure to
implant an aortic valve prosthesis. Prosthesis positioning in transcatheter aortic
valve implantation appears as an important aspect for the success of the inter-
vention. Accordingly, we developed a patient‐specific finite element framework
to predict the insertion of the stiff guidewire, used to position the aortic valve.
We simulated the guidewire insertion for 2 patients based on their pre‐opera-
tive CT scans. The model was designed to primarily predict the position and
the angle of the guidewires in the aortic valve, and the results were successfully
compared with intraoperative images.
The present paper describes extensively the numerical model, which was solved
by using the ANSYS software with an implicit resolution scheme, as well as the
stabilization techniques which were used to overcome numerical instabilities.
We performed sensitivity analysis on the properties of the guidewire (curvature
angle, curvature radius, and stiffness) and the conditions of insertion (insertion
force and orientation). We also explored the influence of the model parameters.
The accuracy of the model was quantitatively evaluated as the distance and the
angle difference between the simulated guidewires and the intraoperative ones.
A good agreement was obtained between the model predictions and intraoper-
ative views available for 2 patient cases. In conclusion, we showed that the
shape of the guidewire in the aortic valve was mainly determined by the geom-
etry of the patient's aorta and by the conditions of insertion (insertion force and
1 | INTRODUCTION
Transcatheter aortic valve implantation (TAVI) is a mini‐invasive procedure to replace aortic valves in the context of aor-
tic stenosis. This procedure consists in delivering a fully collapsible replacement valve (prosthesis) onto the native aortic
valve through a catheter (sheath). A stiff guidewire is first inserted in the patient's aorta with access via the femoral artery.
The function of the guidewire is that of a rail along which the sheath can glide. This function is essential to ensure the
navigation along the aortic arch up to the heart.
The first TAVI procedure was achieved in 2002 by Alain Cribier.
Since then, TAVI has permitted the treatment of
patients who cannot benefit of an open heart surgery.
Nowadays, TAVI shows excellent 1‐year outcomes for both
Received: 13 November 2017 Revised: 11 February 2018 Accepted: 19 February 2018
Int J Numer Meth Biomed Engng. 2018;34:e2974.
Copyright © 2018 John Wiley & Sons, Ltd.wileyonlinelibrary.com/journal/cnm 1of18