Biomechanical Properties of the Thoracic Aneurysmal Wall: Differences Between Bicuspid Aortic Valve and Tricuspid Aortic Valve Patients Caroline Forsell,

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University of Pittsburgh Vascular Bioengineering Laboratory Departments of Surgery and Bioengineering and the McGowan Institute for Regenerative Medicine.

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Biomechanical Properties of the Thoracic Aneurysmal Wall: Differences Between Bicuspid Aortic Valve and Tricuspid Aortic Valve Patients Caroline Forsell, PhD, Hanna M. Björck, PhD, Per Eriksson, PhD, Anders Franco-Cereceda, MD, PhD, T. Christian Gasser, PhD The Annals of Thoracic Surgery Volume 98, Issue 1, Pages 65-71 (July 2014) DOI: 10.1016/j.athoracsur.2014.04.042 Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Position and alignment of wall specimen taken from the aneurysmal ascending aorta during an open heart operation. (B) Dimension (mm) of the pattern blades used for the punch out test. (C) Photograph shows a representative specimen used for the tensile test. The Annals of Thoracic Surgery 2014 98, 65-71DOI: (10.1016/j.athoracsur.2014.04.042) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Bingham distribution function (red area) fitted to experimentally measured fiber orientation function (purple area) of a thoracic aortic aneurysm wall sample (PaBAV9). The Annals of Thoracic Surgery 2014 98, 65-71DOI: (10.1016/j.athoracsur.2014.04.042) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 First Piola-Kirchhoff (PK) stress vs stretch response is shown for a thoracic aortic aneurysm wall sample (PaBAV6). The black lines denote finite element (FE) model prediction, and the gray lines denote in vitro laboratory experimental data. The curve shows typical nonlinear and irreversible features of vascular tissue. As an example, the definitions of failure stress and stretch are included for the FE model prediction. Similar definitions are used for the experimental data. The Annals of Thoracic Surgery 2014 98, 65-71DOI: (10.1016/j.athoracsur.2014.04.042) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Mechanical properties of the thoracic aortic aneurysm (TAA) wall are shown for patients with a bicuspid aortic valve (BAV; gray) and tricuspid aortic valve (TAV; white). (A) First Piola-Kirchhoff (FPK) stress at specimen neck at failure. (B) Average test specimen stretch at failure. (C) Collagen-related stiffness parameter cf of test specimens. (D) Elastin-related stiffness parameter cm of test specimens. Box-and-whisker plots show median (horizontal line), 25% and 75% quantiles (top and bottom borders), minimal and maximal values (whiskers); and the + denotes outliers. The difference between the two patient groups is denoted by the two-sided p value; with n representing the number of samples in the group. The Annals of Thoracic Surgery 2014 98, 65-71DOI: (10.1016/j.athoracsur.2014.04.042) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Correlation is shown between the First Piola-Kirchhoff (PK) stress at the specimen neck at failure with the wall thickness of thoracic aortic aneurysm samples. Data from patients with bicuspid aortic valves (BAV) and tricuspid aortic valves (TAV) are pooled. The * indicates an outlier. The Annals of Thoracic Surgery 2014 98, 65-71DOI: (10.1016/j.athoracsur.2014.04.042) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions