Biomechanical Material Characterization of Stanford Type-B Dissected Porcine Aortas

Aortic dissection (AD) involves tearing of the medial layer, creating a blood-filled channel called false lumen (FL). To treat dissections, clinicians are using endovascular therapy using stent grafts to seal the FL. This procedure has been successful in reducing mortality but has failed in completely re-attaching the torn intimal layer. The use of computational analysis can predict the radial forces needed to devise stents that can treat ADs. To quantify the hyperelastic material behavior for therapy development, we harvested FL wall, true lumen (TL) wall, and intimal flap from the middle and distal part of five dissected aortas. Planar biaxial testing using multiple stretch protocols were conducted on tissue samples to quantify their deformation behavior. A novel non-linear regression model was used to fit data against Holzapfel–Gasser–Ogden hyperelastic strain energy function. The fitting analysis correlated the behavior of the FL and TL walls and the intimal flap to the stiffness observed during tensile loading. It was hypothesized that there is a variability in the stresses generated during loading among tissue specimens derived from different regions of the dissected aorta and hence, one should use region-specific material models when simulating type-B AD. From the data on material behavior analysis, the variability in the tissue specimens harvested from pigs was tabulated using stress and coefficient of variation (CV). The material response curves also compared the changes in compliance observed in the FL wall, TL wall, and intimal flap for middle and distal regions of the dissection. It was observed that for small stretch ratios, all the tissue specimens behaved isotropically with overlapping stress–stretch curves in both circumferential and axial directions. As the stretch ratios increased, we observed that most tissue specimens displayed different structural behaviors in axial and circumferential directions. This observation was very apparent in tissue specimens from mid FL region, less apparent in mid TL, distal FL, and distal flap tissues and least noticeable in tissue specimens harvested from mid flap. Lastly, using mixed model ANOVAS, it was concluded that there were significant differences between mid and distal regions along axial direction which were absent in the circumferential direction.

[1]  John A. Nelder,et al.  A Simplex Method for Function Minimization , 1965, Comput. J..

[2]  Leonard Eugene Dickson,et al.  A Theory of Invariants , 1909 .

[3]  Victor H Barocas,et al.  Planar biaxial mechanical behavior of bioartificial tissues possessing prescribed fiber alignment. , 2009, Journal of biomechanical engineering.

[4]  Douglas L. Mann,et al.  Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 8th edition , 2018 .

[5]  K. Eagle,et al.  Acute aortic dissection , 2008, The Lancet.

[6]  L Speelman,et al.  Initial stress and nonlinear material behavior in patient-specific AAA wall stress analysis , 2009 .

[7]  G. Holzapfel,et al.  Anisotropic mechanical properties of tissue components in human atherosclerotic plaques. , 2004, Journal of biomechanical engineering.

[8]  J. Lopera,et al.  Endovascular treatment of complicated type-B aortic dissection with stent-grafts:: midterm results. , 2003, Journal of vascular and interventional radiology : JVIR.

[9]  M. Breeuwer,et al.  Initial stress and nonlinear material behavior in patient-specific AAA wall stress analysis , 2009 .

[10]  T. Savunen,et al.  Elastin and collagen in the aortic wall: changes in the Marfan syndrome and annuloaortic ectasia. , 1985, Experimental and molecular pathology.

[11]  Yanhang Zhang,et al.  Characterization of Biaxial Mechanical Behavior of Porcine Aorta under Gradual Elastin Degradation , 2013, Annals of Biomedical Engineering.

[12]  H. Turhan,et al.  Traumatic type B aortic dissection causing near total occlusion of aortic lumen and diagnosed by transthoracic echocardiography: A case report. , 2004, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[13]  S. Haulon,et al.  Aortic dissections: new perspectives and treatment paradigms. , 2003, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[14]  A. Yeadon CHEMOPROPHYLAXIS OF MENINGOCOCCAL INFECTION , 1975, The Lancet.

[15]  Stephan Haulon,et al.  Role of Re-entry Tears on the Dynamics of Type B Dissection Flap , 2017, Annals of Biomedical Engineering.

[16]  D. Vorp,et al.  Biomechanics of abdominal aortic aneurysm. , 2007, Journal of biomechanics.

[17]  I. A. Baikin,et al.  X-ray television methods and devices for roentgenogram processing , 1980 .

[18]  R. Ogden,et al.  Hyperelastic modelling of arterial layers with distributed collagen fibre orientations , 2006, Journal of The Royal Society Interface.

[19]  R. Ogden,et al.  A New Constitutive Framework for Arterial Wall Mechanics and a Comparative Study of Material Models , 2000 .

[20]  A Haverich,et al.  Diagnosis and management of aortic dissection , 2001 .

[21]  H. Taghizadeh,et al.  Evaluation of Biaxial Mechanical Properties of Aortic Media Based on the Lamellar Microstructure , 2015, Materials.

[22]  Anju R. Babu,et al.  Biomechanical Properties of Human Ascending Thoracic Aortic Dissections. , 2015, Journal of biomechanical engineering.

[23]  Sang Joon Park,et al.  Problems encountered during and after stent-graft treatment of aortic dissection. , 2006, Journal of vascular and interventional radiology : JVIR.

[24]  A Evangelista,et al.  The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. , 2000, JAMA.

[25]  Gerhard Sommer,et al.  3D constitutive modeling of the biaxial mechanical response of intact and layer-dissected human carotid arteries. , 2012, Journal of the mechanical behavior of biomedical materials.

[26]  K. Eagle,et al.  Aortic dissection: new frontiers in diagnosis and management: Part I: from etiology to diagnostic strategies. , 2003, Circulation.

[27]  Stavroula Balabani,et al.  Aortic dissection simulation models for clinical support: fluid-structure interaction vs. rigid wall models , 2015, Biomedical engineering online.

[28]  M L Raghavan,et al.  Toward a biomechanical tool to evaluate rupture potential of abdominal aortic aneurysm: identification of a finite strain constitutive model and evaluation of its applicability. , 2000, Journal of biomechanics.

[29]  N. Fatouraee,et al.  Biaxial mechanical properties of human ureter under tension. , 2014, Urology journal.

[30]  W. Cleveland Robust Locally Weighted Regression and Smoothing Scatterplots , 1979 .

[31]  J. Burša,et al.  Biaxial Tension Tests with Soft Tissues of Arterial Wall , 2009 .

[32]  M. Sacks Biaxial Mechanical Evaluation of Planar Biological Materials , 2000 .

[33]  S. Haulon,et al.  Validated Computational Model to Compute Re-apposition Pressures for Treating Type-B Aortic Dissections , 2018, Front. Physiol..

[34]  Gerhard A. Holzapfel,et al.  A viscoelastic model for fiber-reinforced composites at finite strains: Continuum basis, computational aspects and applications , 2001 .

[35]  Mark B Ratcliffe,et al.  The biomechanics of arterial elastin. , 2009, Journal of the mechanical behavior of biomedical materials.

[36]  E. Bradley,et al.  Length-force and volume-pressure relationships of arteries. , 1977 .

[37]  W. Roberts,et al.  Aortic dissection: anatomy, consequences, and causes. , 1981, American heart journal.

[38]  K. Eagle,et al.  Acute type B aortic dissection: insights from the International Registry of Acute Aortic Dissection. , 2014, Annals of cardiothoracic surgery.

[39]  M. Sacks,et al.  Biaxial mechanical properties of the native and glutaraldehyde-treated aortic valve cusp: Part II--A structural constitutive model. , 2000, Journal of biomechanical engineering.

[40]  Ghassan S. Kassab,et al.  Role of Pulse Pressure and Geometry of Primary Entry Tear in Acute Type B Dissection Propagation , 2016, Annals of Biomedical Engineering.

[41]  M. Gilchrist,et al.  Influence of preservation temperature on the measured mechanical properties of brain tissue. , 2013, Journal of biomechanics.

[42]  K. Eagle,et al.  Aortic Dissection , 2008, Circulation.

[43]  M. J. Thubrikar, M. Labrosse, F. Robicsek, J. Al-Soud Mechanical properties of abdominal aortic aneurysm wall , 2001 .

[44]  G. Kassab,et al.  Constitutive modeling of the passive inflation-extension behavior of the swine colon. , 2018, Journal of the mechanical behavior of biomedical materials.

[45]  G A Holzapfel,et al.  Determination of constitutive equations for human arteries from clinical data. , 2003, Journal of biomechanics.

[46]  Salvatore Pasta,et al.  Effect of aneurysm on the mechanical dissection properties of the human ascending thoracic aorta. , 2012, The Journal of thoracic and cardiovascular surgery.

[47]  H. Eastcott,et al.  ACUTE DISSECTION OF THE AORTA: LONG-TERM REVIEW AND MANAGEMENT , 1980, The Lancet.