Mechanical Characterization and Material Modeling of Ascending Aortic Aneurysm with Different Bicuspid Aortic Cusp Fusion Morphologies

Bicuspid aortic valve (BAV) is frequently associated with ascending thoracic aortic aneurysm (ATAA). Impact of cusp fusion patterns on biomechanics and microstructure of the ATAA remains unknown. This study aims to investigate biaxial mechanical properties of the ATAAs with right-left (RL) and right-noncoronary (RN) cusp fusion patterns. Fresh ATAA samples (n = 26) were obtained from patients who underwent surgical aneurysm repair. Biaxial extension tests were performed to characterize mechanical behaviors of the RL and RN BAV-ATAAs. A material model was fitted to biaxial experimental data to obtain model parameters. Histological and mass fraction analyses were employed to investigate the underlying microstructure and dry weight percentages of elastin and collagen in the ATAA tissue. The RL and RN BAV-ATAAs exhibited nonlinear and anisotropic mechanical responses to biaxial loading. Tissue stiffness of the RN BAV-ATAAs was significantly higher than that of the RL BAV-ATAAs in the circumferential (2679 ± 755 vs 1942 ± 578 kPa, mean ± SD, p = 0.04) and longitudinal (2535 ± 630 vs 1709 ± 512 kPa, mean ± SD, p = 0.02) directions under the equibiaxial stresses. Laminar structure of elastic fibers was disrupted in both RL and RN BAV-ATAAs. Notably, interstitial fibrosis and thinner elastic fibers were identified in the RN BAV-ATAAs. Mass fraction of collagen was significantly higher for the RN BAV-ATAAs than that of the RL BAV-ATAAs. The tissue stiffness in the circumferential direction was significantly increased and strongly correlated with the mass fractions of collagen for both RL and RN BAV-ATAAs. Our results suggest that elastic properties of the RN BAV-ATAAs are more deteriorated than those of the RL BAV-ATAAs. Changes in biomechanical properties may have great impact on ascending aortic dilation.