The glutaraldehyde-stabilized porcine aortic valve xenograft. II. Effect of fixation with or without pressure on the tensile viscoelastic properties of the leaflet material

3D Printing Type 1 Bovine Collagen Scaffolds for Tissue Engineering Applications-Physicochemical Characterization and In Vitro Evaluation

Collagen, an abundant extracellular matrix protein, has shown hemostatic, chemotactic, and cell adhesive characteristics, making it an attractive choice for the fabrication of tissue engineering scaffolds. The aim of this study was to synthesize a fibrillar colloidal gel from Type 1 bovine collagen, as well as three dimensionally (3D) print scaffolds with engineered pore architectures. 3D-printed scaffolds were also subjected to post-processing through chemical crosslinking (in N-(3-Dimethylaminopropyl)-N'-ethylcarbodiimide) and lyophilization. The scaffolds were physicochemically characterized through Fourier Transform Infrared Spectroscopy (FTIR), Thermogravimetric Analysis, Differential Scanning Calorimetry, and mechanical (tensile) testing. In vitro experiments using Presto Blue and Alkaline Phosphatase assays were conducted to assess cellular viability and the scaffolds' ability to promote cellular proliferation and differentiation. Rheological analysis indicated shear thinning capabilities in the collagen gels. Crosslinked and lyophilized 3D-printed scaffolds were thermally stable at 37 °C and did not show signs of denaturation, although crosslinking resulted in poor mechanical strength. PB and ALP assays showed no signs of cytotoxicity as a result of crosslinking. Fibrillar collagen was successfully formulated into a colloidal gel for extrusion through a direct inkjet writing printer. 3D-printed scaffolds promoted cellular attachment and proliferation, making them a promising material for customized, patient-specific tissue regenerative applications.

Enhance Fracture Toughness and Fatigue Resistance of Hydrogels by Reversible Alignment of Nanofibers

Biological tissues, such as heart valve, tendon, etc., possess excellent mechanical properties, which arises from their inherent anisotropic arrangement of soft and hard phases. Inspired by the anisotropic structures, many methods have been developed to synthesize hydrogels that can achieve mechanical properties comparable to biological tissues. Here, we describe a new method to enhance fracture toughness and fatigue resistance of hydrogels by introducing nanofibers which can reversibly align with elastic deformation to form an anisotropic structure. As a demonstration, we introduce stiff, rod-like cellulose nanocrystals (CNCs) into a polyacrylamide (PAAm) network. CNCs aggregate into clusters to form hard phases and entangle with the PAAm network. The CNC/PAAm composite hydrogel is initially isotropic, becomes anisotropic upon loading, and recovers to be isotropic upon unloading. During the deformation, the aligned CNC clusters at the crack tip can transmit the stress over the size of the cluster, effectively resisting crack growth. We use photoelasticity and small-angle X-ray scattering (SAXS) tests to observe the change of microstructures associated with deformation. The fracture toughness of CNC/PAAm hydrogels with different sizes of CNCs can reach 1000 J/m². The fatigue threshold is about 100 J/m², an order of magnitude higher than that of PAAm hydrogel. This work provides a simple and general method to strengthen hydrogels under both monotonic and cyclic loads.

Soft Materials by Design: Unconventional Polymer Networks Give Extreme Properties

Hydrogels are polymer networks infiltrated with water. Many biological hydrogels in animal bodies such as muscles, heart valves, cartilages, and tendons possess extreme mechanical properties including being extremely tough, strong, resilient, adhesive, and fatigue-resistant. These mechanical properties are also critical for hydrogels' diverse applications ranging from drug delivery, tissue engineering, medical implants, wound dressings, and contact lenses to sensors, actuators, electronic devices, optical devices, batteries, water harvesters, and soft robots. Whereas numerous hydrogels have been developed over the last few decades, a set of general principles that can rationally guide the design of hydrogels using different materials and fabrication methods for various applications remain a central need in the field of soft materials. This review is aimed at synergistically reporting: (i) general design principles for hydrogels to achieve extreme mechanical and physical properties, (ii) implementation strategies for the design principles using unconventional polymer networks, and (iii) future directions for the orthogonal design of hydrogels to achieve multiple combined mechanical, physical, chemical, and biological properties. Because these design principles and implementation strategies are based on generic polymer networks, they are also applicable to other soft materials including elastomers and organogels. Overall, the review will not only provide comprehensive and systematic guidelines on the rational design of soft materials, but also provoke interdisciplinary discussions on a fundamental question: why does nature select soft materials with unconventional polymer networks to constitute the major parts of animal bodies?

Poly(ethylene glycol)-Based Coatings for Bioprosthetic Valve Tissues: Toward Restoration of Physiological Behavior

Bioprosthetic valves (BPVs) have a limited lifespan in the body necessitating repeated surgeries to replace the failed implant. Early failure of these implants has been linked to various surface properties of the valve. Surface properties of BPVs are significantly different from physiological valves because of the fixation process used when processing the xenograft tissue. To improve the longevity of BPVs, efforts need to be taken to improve the surface properties and shield the implant from the bodily interactions that degrade it. Toward this goal, we evaluated the use of hydrogel coatings to attach to the BPV tissue and impart surface properties that are close to physiological. Hydrogels are well characterized for their biocompatibility and highly tunable surface characteristics. Using a previously published coating method, we deposited hydrogel coatings of poly(ethylene glycol)diacrylate (PEGDA) and poly(ethylene glycol)diacrylamide (PEGDAA) atop BPV samples. Coated samples were evaluated against the physiological tissue and uncoated glutaraldehyde-fixed tissue for deposition of hydrogel, surface adherence, mechanical properties, and fixation properties. Results showed both PEGDA- and PEGDAA-deposited coatings were nearly continuous across the valve leaflet surface. Further, the PEGDA- and PEGDAA-coated samples showed restoration of physiological levels of protein adhesion and mechanical stiffness. Interestingly, the coating process rather than the coating itself altered the material behavior yet did not alter the cross-linking from fixation. These results show that the PEG-based coatings for BPVs can successfully alter surface properties of BPVs and help promote physiological characteristics without interfering with the necessary fixation.

Rate-Dependent and Relaxation Properties of Porcine Aortic Heart Valve Biomaterials

Objective: This work evaluates the rate-dependent and relaxation properties of native porcine heart valves, glutaraldehyde fixed porcine pericardium, and decellularized sterilized porcine pericardium. Methods: Biaxial tension testing was performed at strain-rates of 0.001 s⁻¹, 0.01 s⁻¹, 0.1 s⁻¹, and 1 s⁻¹. Finally, relaxation testing for 300 s was performed on all heart valve biomaterials. Results: No notable rate-dependent response was observed for any of the three biomaterials with few significant differences between any strain-rates. For relaxation testing, native tissues showed the most pronounced drop in stress and glutaraldehyde the lowest drop in stress although no tissues showed anisotropy in the relaxation. Conclusions: Increasing the strain-rate of the three biomaterials considered does not increase the stress within the tissue. This indicates that there will not be increased fatigue from accelerated wear testing compared to loading at physiological strain-rates as the increase strain-rates would likely not significantly alter the tissue stress.

Biomechanical modeling of transcatheter aortic valve replacement in a stenotic bicuspid aortic valve: deployments and paravalvular leakage

Calcific aortic valve disease (CAVD) is characterized by stiffened aortic valve leaflets. Bicuspid aortic valve (BAV) is the most common congenital heart disease. Transcatheter aortic valve replacement (TAVR) is a treatment approach for CAVD where a stent with mounted bioprosthetic valve is deployed on the stenotic valve. Performing TAVR in calcified BAV patients may be associated with post-procedural complications due to the BAV asymmetrical structure. This study aims to develop refined computational models simulating the deployments of Evolut R and PRO TAVR devices in a representative calcified BAV. The paravalvular leakage (PVL) was also calculated by computational fluid dynamics simulations. Computed tomography scan of severely stenotic BAV patient was acquired. The 3D calcium deposits were generated and embedded inside a parametric model of the BAV. Deployments of the Evolut R and PRO inside the calcified BAV were simulated in five bioprosthesis leaflet orientations. The hypothesis of asymmetric and elliptic stent deployment was confirmed. Positioning the bioprosthesis commissures aligned with the native commissures yielded the lowest PVL (15.7 vs. 29.5 mL/beat). The Evolut PRO reduced the PVL in half compared with the Evolut R (15.7 vs. 28.7 mL/beat). The proposed biomechanical computational model could optimize future TAVR treatment in BAV patients. Graphical abstract.

Planar biaxial testing of heart valve cusp replacement biomaterials: Experiments, theory and material constants

OBJECTIVES

Aortic valve (AV) repair has become an attractive option to correct aortic insufficiency. Yet, cusp reconstruction with various cusp replacement materials has been associated with greater long-term repair failures, and it is still unknown how such materials mechanically compare with native leaflets. We used planar biaxial testing to characterize six clinically relevant cusp replacement materials, along with native porcine AV leaflets, to ascertain which materials would be best suited for valve repair.

METHODS

We tested at least six samples of: 1) fresh autologous porcine pericardium (APP), 2) glutaraldehyde fixed porcine pericardium (GPP), 3) St Jude Medical pericardial patch (SJM), 4) CardioCel patch (CC), 5) PeriGuard (PG), 6) Supple PeriGuard (SPG) and 7) fresh porcine AV leaflets (PC). We introduced efficient displacement-controlled testing protocols and processing, as well as advanced convexity requirements on the strain energy functions used to describe the mechanical response of the materials under loading.

RESULTS

The proposed experimental and data processing pipeline allowed for a robust in-plane characterization of all the materials tested, with constants determined for two Fung-like hyperelastic, anisotropic strain energy models.

CONCLUSIONS

Overall, CC and SPG (respectively PG) patches ranked as the closest mechanical equivalents to young (respectively aged) AV leaflets. Because the native leaflets as well as CC, PG and SPG patches exhibit significant anisotropic behaviors, it is suggested that the fiber and cross-fiber directions of these replacement biomaterials be matched with those of the host AV leaflets.

STATEMENT OF SIGNIFICANCE

The long-term performance of cusp replacement materials would ideally be evaluated in large animal models for AV disease and cusp repair, and over several months or more. Given the unavailability and impracticality of such models, detailed information on stress-strain behavior, as studied herein, and investigations of durability and valve dynamics will be the best surrogates, as they have been for prosthetic valves. Overall, comparison with Fig. 3 suggests that CC and SPG (respectively PG) patches may be the closest mechanical equivalents to young (respectively aged) AV leaflets. Interestingly, the thicknesses of these materials are close to those reported for porcine and younger human AV leaflets, which may facilitate surgical implantation, by contrast to the thinner APP which has poor handling qualities. Because the native leaflets as well as CC, PG and SPG patches exhibit anisotropic behaviors, from a mechanistic perspective alone, it stands to reason that cardiac surgeons should seek to intraoperatively match the fiber and cross-fiber directions of these replacement biomaterials with those of the repaired AV leaflets.

Biomechanical Behavior of Bioprosthetic Heart Valve Heterograft Tissues: Characterization, Simulation, and Performance

The use of replacement heart valves continues to grow due to the increased prevalence of valvular heart disease resulting from an ageing population. Since bioprosthetic heart valves (BHVs) continue to be the preferred replacement valve, there continues to be a strong need to develop better and more reliable BHVs through and improved the general understanding of BHV failure mechanisms. The major technological hurdle for the lifespan of the BHV implant continues to be the durability of the constituent leaflet biomaterials, which if improved can lead to substantial clinical impact. In order to develop improved solutions for BHV biomaterials, it is critical to have a better understanding of the inherent biomechanical behaviors of the leaflet biomaterials, including chemical treatment technologies, the impact of repetitive mechanical loading, and the inherent failure modes. This review seeks to provide a comprehensive overview of these issues, with a focus on developing insight on the mechanisms of BHV function and failure. Additionally, this review provides a detailed summary of the computational biomechanical simulations that have been used to inform and develop a higher level of understanding of BHV tissues and their failure modes. Collectively, this information should serve as a tool not only to infer reliable and dependable prosthesis function, but also to instigate and facilitate the design of future bioprosthetic valves and clinically impact cardiology.

Evaluation of bioprosthetic heart valve failure using a matrix-fibril shear stress transfer approach

A matrix-fibril shear stress transfer approach is devised and developed in this paper to analyse the primary biomechanical factors which initiate the structural degeneration of the bioprosthetic heart valves (BHVs). Using this approach, the critical length of the collagen fibrils l c and the interface shear acting on the fibrils in both BHV and natural aortic valve (AV) tissues under physiological loading conditions are calculated and presented. It is shown that the required critical fibril length to provide effective reinforcement to the natural AV and the BHV tissue is l c  = 25.36 µm and l c  = 66.81 µm, respectively. Furthermore, the magnitude of the required shear force acting on fibril interface to break a cross-linked fibril in the BHV tissue is shown to be 38 µN, while the required interfacial force to break the bonds between the fibril and the surrounding extracellular matrix is 31 µN. Direct correlations are underpinned between these values and the ultimate failure strength and the failure mode of the BHV tissue compared with the natural AV, and are verified against the existing experimental data. The analyses presented in this paper explain the role of fibril interface shear and critical length in regulating the biomechanics of the structural failure of the BHVs, for the first time. This insight facilitates further understanding into the underlying causes of the structural degeneration of the BHVs in vivo.

The Sustainable Release of Vancomycin and Its Degradation Products From Nanostructured Collagen/Hydroxyapatite Composite Layers

Infections of the musculoskeletal system present a serious problem with regard to the field of orthopedic and trauma medicine. The aim of the experiment described in this study was to develop a resorbable nanostructured composite layer with the controlled elution of antibiotics. The layer is composed of collagen, hydroxyapatite nanoparticles, and vancomycin hydrochloride (10 wt%). The stability of the collagen was enhanced by means of cross-linking. Four cross-linking agents were studied, namely an ethanol solution, a phosphate buffer solution of N-(3-dimethylaminopropyl)-N'-ethylcarbodiimide hydrochloride/N-hydroxysuccinimide, genipin, and nordihydroguaiaretic acid. High performance liquid chromatography was used so as to characterize the in vitro release rates of the vancomycin and its crystalline degradation antibiotically inactive products over a 21-day period. The maximum concentration of the released active form of vancomycin (approximately 265 mg/L) exceeded the minimum inhibitory concentration up to an order of 17 times without triggering the burst releasing effect. At the end of the experiment, the minimum inhibitory concentration was exceeded by up to 6 times (approximately 100 mg/L). It was determined that the modification of collagen with hydroxyapatite nanoparticles does not negatively influence the sustainable release of vancomycin. The balance of vancomycin and its degradation products was observed after 14 days of incubation.

Development of an In Vitro Model to Characterize the Effects of Transcatheter Aortic Valve on Coronary Artery Flow

Impairment of coronary artery flow, in either acute or chronic conditions, is a severe complication of transcatheter aortic valve (TAV) implantation, which can arise due to improper TAV positioning. However, little work has been done to quantify the effects of the TAV positioning on the coronary flow. In this study, a realistic in vitro model of coronary artery flow was developed and used to investigate the impact of TAV deployed orientations on coronary flow. The coronary hemodynamics was first replicated mathematically using a lumped parameter model with time-varying myocardial resistance. Based on the analytical model, two stepper motor controlled stopcock valves were integrated in a left heart simulator to represent the variable myocardial resistance in the experimental setup. The coronary flow and pressure waveforms obtained from the in vitro system were consistent with published data. With a TAV deployed in different orientations, the measured results demonstrated that TAV orientation does not have a significant impact on the coronary flow. The developed in vitro model can be further utilized to simulate coronary flow under various pathological conditions.

Integrating valve-inspired design features into poly(ethylene glycol) hydrogel scaffolds for heart valve tissue engineering

The development of advanced scaffolds that recapitulate the anisotropic mechanical behavior and biological functions of the extracellular matrix in leaflets would be transformative for heart valve tissue engineering. In this study, anisotropic mechanical properties were established in poly(ethylene glycol) (PEG) hydrogels by crosslinking stripes of 3.4 kDa PEG diacrylate (PEGDA) within 20 kDa PEGDA base hydrogels using a photolithographic patterning method. Varying the stripe width and spacing resulted in a tensile elastic modulus parallel to the stripes that was 4.1-6.8 times greater than that in the perpendicular direction, comparable to the degree of anisotropy between the circumferential and radial orientations in native valve leaflets. Biomimetic PEG-peptide hydrogels were prepared by tethering the cell-adhesive peptide RGDS and incorporating the collagenase-degradable peptide PQ (GGGPQG↓IWGQGK) into the polymer network. The specific amounts of RGDS and PEG-PQ within the resulting hydrogels influenced the elongation, de novo extracellular matrix deposition and hydrogel degradation behavior of encapsulated valvular interstitial cells (VICs). In addition, the morphology and activation of VICs grown atop PEG hydrogels could be modulated by controlling the concentration or micro-patterning profile of PEG-RGDS. These results are promising for the fabrication of PEG-based hydrogels using anatomically and biologically inspired scaffold design features for heart valve tissue engineering.

The tensile and viscoelastic properties of aortic valve leaflets treated with a hyaluronidase gradient

Purpose

When diseased, aortic valves are typically replaced with bioprosthetic heart valves (BPHVs), porcine valves or bovine pericardium that are fixed in glutaraldehyde. These replacements fail within 10-15 years due to calcification and fatigue, and their failure coincides with a loss of glycosaminoglycans (GAGs). This study investigates this relationship between GAG concentration and the tensile and viscoelastic properties of aortic valve leaflets.

Methods

Aortic valve leaflets were dissected from porcine hearts and digested in hyaluronidase in concentrations ranging from 0-5 U/mL for 0-24 hours, yielding a spectrum of GAG concentrations that was measured using the uronic acid assay and confirmed by Alcian Blue staining. Digested leaflets with varying GAG concentrations were then tested in tension in the circumferential and radial directions with varying strain rate, as well as in stress relaxation.

Results

The GAG concentration of the leaflets was successfully reduced using hyaluronidase, although water content was not affected. Elastic modulus, the maximum stress, and hysteresis significantly increased with decreasing GAG concentration. Extensibility and the radius of transition curvature did not change with GAG concentration. The stress relaxation behavior and strain-rate independent nature of the leaflet did not change with GAG concentration.

Conclusions

These results suggest that GAGs in the spongiosa lubricate tissue motion and reduce stresses experienced by the leaflet. This study forms the basis for predictive models of BPHV mechanics based on GAG concentration, and guides the rational design of future heart valve replacements.

On the biomechanics of heart valve function

Heart valves (HVs) are fluidic control components of the heart that ensure unidirectional blood flow during the cardiac cycle. However, this description does not adequately describe the biomechanical ramifications of their function in that their mechanics are multi-modal. Moreover, they must replicate their cyclic function over an entire lifetime, with an estimated total functional demand of least 3x10(9) cycles. The focus of the present review is on the functional biomechanics of heart valves. Thus, the focus of the present review is on functional biomechanics, referring primarily to biosolid as well as several key biofluid mechanical aspects underlying heart valve physiological function. Specifically, we refer to the mechanical behaviors of the extracellular matrix structural proteins, underlying cellular function, and their integrated relation to the major aspects of valvular hemodynamic function. While we focus on the work from the author's laboratories, relevant works of other investigators have been included whenever appropriate. We conclude with a summary of important future trends.

Glutaraldehyde cross-linking of tendon--mechanical effects at the level of the tendon fascicle and fibril

Conclusive insight into the microscopic principles that govern the strength of tendon and related connective tissues is lacking and the importance of collagen cross-linking has not been firmly established. The combined application of whole-tissue mechanical testing and atomic force spectroscopy allowed for a detailed characterization of the effect of cross-linking in rat-tail tendon. The cross-link inducing agent glutaraldehyde augmented the tensile strength of tendon fascicles. Stress at failure increased from approximately 8 MPa to approximately 39 MPa. The mechanical effects of glutaraldehyde at the tendon fibril level were examined by atomic force microscopy. Peak forces increased from approximately 1379 to approximately 2622 pN while an extended Hertz fit of force-indentation data showed a approximately 24 fold increase in Young's modulus on indentation. The effect of glutaraldehyde cross-linking on the tensile properties of a single collagen fibril was investigated by a novel methodology based on atomic force spectroscopy. The Young's modulus of a secluded fibril increased from approximately 407 MPa to approximately 1.1 GPa with glutaraldehyde treatment. Collectively, the findings indicate that cross-linking at the level of the collagen fibril is of key importance for the mechanical strength of tendon tissue. However, when comparing the effects at the level of the tendon fascicle and fibril, respectively, further questions are prompted regarding the pathways of force through the tendon microstructure as fibril strength seems to surpass that of the tendon fascicle.

Tissue-engineered heart valve prostheses: ‘state of the heart’

In this article, we will review the current state of the art in heart valve tissue engineering. We provide an overview of mechanical and biological replacement options, outlining advantages and limitations of each option. Tissue engineering, as a field, is introduced, and specific aspects of valve tissue engineering are discussed (e.g., biomaterials, cells and bioreactors). Technological hurdles, which need to be overcome for advancement of the field, are also discussed.

Heart valve function: a biomechanical perspective

Heart valves (HVs) are cardiac structures whose physiological function is to ensure directed blood flow through the heart over the cardiac cycle. While primarily passive structures that are driven by forces exerted by the surrounding blood and heart, this description does not adequately describe their elegant and complex biomechanical function. Moreover, they must replicate their cyclic function over an entire lifetime, with an estimated total functional demand of least 3x10(9) cycles. As in many physiological systems, one can approach HV biomechanics from a multi-length-scale approach, since mechanical stimuli occur and have biological impact at the organ, tissue and cellular scales. The present review focuses on the functional biomechanics of HVs. Specifically, we refer to the unique aspects of valvular function, and how the mechanical and mechanobiological behaviours of the constituent biological materials (e.g. extracellular matrix proteins and cells) achieve this remarkable feat. While we focus on the work from the authors' respective laboratories, the works of most investigators known to the authors have been included whenever appropriate. We conclude with a summary and underscore important future trends.

Bioprosthetic heart valve heterograft biomaterials: structure, mechanical behavior and computational simulation

The present review surveys significant developments in the biomechanical characterization and computational simulation of biologically derived chemically cross-linked soft tissues, or 'heterograft' biomaterials, used in replacement bioprosthetic heart valve (BHV). A survey of mechanical characterization techniques, relevant mechanical properties and computational simulation approaches is presented for both the source tissues and cross-linked biomaterials. Since durability remains the critical problem with current bioprostheses, changes with the mechanical behavior with fatigue are also presented. Moreover, given the complex nature of the mechanical properties of heterograft biomaterials it is not surprising that most constitutive (stress-strain) models, historically used to characterize their behavior, were oversimplified. Simulations of BHV function utilizing these models have inevitably been inaccurate. Thus, more recent finite element simulations utilizing nonlinear constitutive models, which achieve greater model fidelity, are reviewed. An important conclusion of this review is the need for accurate constitutive models, rigorously validated with appropriate experimental data, in order that the design benefits of computational models can be realized. Finally, for at least the coming 20 years, BHVs fabricated from heterograft biomaterials will continue to be extensively used, and will probably remain as the dominant valve design. We should thus recognize that rational, scientifically based approaches to BHV biomaterial development and design can lead to significantly improved BHV, over the coming decades, which can potentially impact millions of patients worldwide with heart valve disease.

EDC cross-linking improves skin substitute strength and stability

Collagen-based scaffolds are extensively utilized as an analog for the extracellular matrix in cultured skin substitutes (CSS). To improve the mechanical properties and degradation rates of collagen scaffolds, chemical cross-linking is commonly employed. In this study, freeze-dried collagen-GAG sponges were crosslinked with increasing concentrations of 1-ethyl-3-3-dimethylaminopropylcarbodiimide hydrochloride (EDC; 0, 1, 5, 10, 50mm). Cross-linking with EDC at concentrations >1mm was shown to greatly decrease degradation by collagenase up to 21 days. Ultimate tensile strength (UTS) of acellular collagen sponges scaled positively with EDC concentration up to 10mm. At 50mm EDC, the UTS decreased dramatically likely due to the brittle nature of the highly crosslinked material. Co-culture of human fibroblasts (HF) and keratinocytes (HK) on these substrates reveals an apparent cytotoxicty of the EDC at high concentrations with reduced cell viability and poor cellular organization in CSS fabricated with scaffolds crosslinked with 10 or 50mm EDC. From the data gathered in this study, intermediate concentrations of EDC, specifically 5mm, increase collagen sponge stability and strength while providing an environment in which HF and HK can attach, proliferate and organize in a manner conducive to dermal and epidermal regeneration.

Influence of different collagen species on physico-chemical properties of crosslinked collagen matrices

Collagen-based scaffolds are appealing products for the repair of cartilage defects using tissue engineering strategies. The present study investigated the species-related differences of collagen scaffolds with and without 1-ethyl-3-(3-dimethyl aminopropyl) carbodiimide (EDC)/N-hydroxysuccinimide (NHS)-crosslinking. Resistance against collagenase digestion, swelling ratio, amino acid sequence, shrinkage temperature, ultrastructural matrix morphology, crosslinking density and stress-strain characteristics were determined to evaluate the physico-chemical properties of equine- and bovine-collagen-based scaffolds. Three-factor ANOVA analysis revealed a highly significant effect of collagen type (p=0.0001), crosslinking (p=0.0001) and time (p=0.0001) on degradation of the collagen samples by collagenase treatment. Crosslinked equine collagen samples showed a significantly reduced swelling ratio compared to bovine collagen samples (p< 0.0001). The amino acid composition of equine collagen revealed a higher amount of hydroxylysine and lysine. Shrinkage temperatures of non-crosslinked samples showed a significant difference between equine (60 degrees C) and bovine collagen (57 degrees C). Three-factor ANOVA analysis revealed a highly significant effect of collagen type (p=0.0001), crosslinking (p=0.0001) and matrix condition (p=0.0001) on rupture strength measured by stress-strain analysis. The ultrastructure, the crosslinking density and the strain at rupture between collagen matrices of both species showed no significant differences. For tissue engineering purposes, the higher enzymatic stability, the higher form stability, as well as the lower risk of transmissible disease make the case for considering equine-based collagen. This study also indicates that results obtained for scaffolds based on a certain collagen species may not be transferable to scaffolds based on another, because of the differing physico-chemical properties.

Biaxial mechanical properties of the native and glutaraldehyde-treated aortic valve cusp: Part II--A structural constitutive model

We have formulated the first constitutive model to describe the complete measured planar biaxial stress-strain relationship of the native and glutaraldehyde-treated aortic valve cusp using a structurally guided approach. When applied to native, zero-pressure fixed, and low-pressure fixed cusps, only three parameters were needed to simulate fully the highly anisotropic, and nonlinear in-plane biaxial mechanical behavior. Differences in the behavior of the native and zero- and low-pressure fixed cusps were found to be primarily due to changes in the effective fiber stress-strain behavior. Further, the model was able to account for the effects of small (< 10 deg) misalignments in the cuspal specimens with respect to the biaxial test axes that increased the accuracy of the model material parameters. Although based upon a simplified cuspal structure, the model underscored the role of the angular orientation of the fibers that completely accounted for extreme mechanical anisotropy and pronounced axial coupling. Knowledge of the mechanics of the aortic cusp derived from this model may aid in the understanding of fatigue damage in bioprosthetic heart valves and, potentially, lay the groundwork for the design of tissue-engineered scaffolds for replacement heart valves.

Biaxial mechanical properties of the natural and glutaraldehyde treated aortic valve cusp--Part I: Experimental results

To date, there are no constitutive models for either the natural or bioprosthetic aortic valve (AV), in part due to experimental complications related to the AV's small size and heterogeneous fibrous structure. In this study, we developed specialized biaxial testing techniques for the AV cusp, including a method to determine the local structure-strain relationship to assess the effects of boundary tethering forces. Natural and glutaraldehyde (GL) treated cusps were subjected to an extensive biaxial testing protocol in which the ratios of the axial tensions were held at constant values. Results indicated that the local fiber architecture clearly dominated cuspal deformation, and that the tethering effects at the specimen boundaries were negligible. Due to unique aspects of cuspal fiber architecture, the most uniform region of deformation was found at the lower portion as opposed to the center of the cuspal specimen. In general, the circumferential strains were much smaller than the radial strains, indicating a profound degree of mechanical anisotropy, and that natural cusps were significantly more extensible than the GL treated cusps. Strong mechanical coupling between biaxial stretch axes produced negative circumferential strains under equibiaxial tension. Further, the large radial strains observed could not be explained by uncrimping of the collagen fibers, but may be due to large rotations of the highly aligned, circumferential-oriented collagen fibers in the fibrosa. In conclusion, this study provides new insights into the AV cusp's structure-function relationship in addition to requisite data for constitutive modeling.

Founder's Award, 25th Annual Meeting of the Society for Biomaterials, perspectives. Providence, RI, April 28-May 2, 1999. Tissue heart valves: current challenges and future research perspectives

Substitute heart valves composed of human or animal tissues have been used since the early 1960s, when aortic valves obtained fresh from human cadavers were transplanted to other individuals as allografts. Today, tissue valves are used in 40% or more of valve replacements worldwide, predominantly as stented porcine aortic valves (PAV) and bovine pericardial valves (BPV) preserved by glutaraldehyde (GLUT) (collectively termed bioprostheses). The principal disadvantage of tissue valves is progressive calcific and noncalcific deterioration, limiting durability. Native heart valves (typified by the aortic valve) are cellular and layered, with regional specializations of the extracellular matrix (ECM). These elements facilitate marked repetitive changes in shape and dimension throughout the cardiac cycle, effective stress transfer to the adjacent aortic wall, and ongoing repair of injury incurred during normal function. Although GLUT bioprostheses mimic natural aortic valve structure (a) their cells are nonviable and thereby incapable of normal turnover or remodeling ECM proteins; (b) their cuspal microstructure is locked into a configuration which is at best characteristic of one phase of the cardiac cycle (usually diastole); and (c) their mechanical properties are markedly different from those of natural aortic valve cusps. Consequently, tissue valves suffer a high rate of progressive and age-dependent structural valve deterioration resulting in stenosis or regurgitation (>50% of PAV overall fail within 10-15 years; the failure rate is nearly 100% in 5 years in those <35 years old but only 10% in 10 years in those >65). Two distinct processes-intrinsic calcification and noncalcific degradation of the ECM-account for structural valve deterioration. Calcification is a direct consequence of the inability of the nonviable cells of the GLUT-preserved tissue to maintain normally low intracellular calcium. Consequently, nucleation of calcium-phosphate crystals occurs at the phospholipid-rich membranes and their remnants. Collagen and elastin also calcify. Tissue valve mineralization has complex host, implant, and mechanical determinants. Noncalcific degradation in the absence of physiological repair mechanisms of the valvular structural matrix is increasingly being appreciated as a critical yet independent mechanism of valve deterioration. These degradation mechanisms are largely rationalized on the basis of the changes to natural valves when they are fabricated into a tissue valve (mentioned above), and the subsequent interactions with the physiologic environment that are induced following implantation. The "Holy Grail" is a nonobstructive, nonthrombogenic tissue valve which will last the lifetime of the patient (and potentially grow in maturing recipients). There is considerable activity in basic research, industrial development, and clinical investigation to improve tissue valves. Particularly exciting in concept, yet early in practice is tissue engineering, a technique in which an anatomically appropriate construct containing cells seeded on a resorbable scaffold is fabricated in vitro, then implanted. Remodeling in vivo, stimulated and guided by appropriate biological signals incorporated into the construct, is intended to recapitulate normal functional architecture.

Mechanical properties of a porcine aortic valve fixed with a naturally occurring crosslinking agent

The study investigates the mechanical properties of porcine aortic valve leaflets fixed with a naturally occurring crosslinking agent, genipin, at distinct pressure heads. Fresh and the glutaraldehyde-fixed counterparts were used as controls. Subsequent to fixation, the changes in leaflet collagen crimps and its surface morphology were investigated by light microscopy and scanning electron microscopy (SEM). Also, the crosslinking characteristics of each studied group were determined by measuring its fixation index and denaturation temperature. In the mechanical testing, tissue strips made from each studied group were examined in both the circumferential and radial directions. Histological and SEM comparisons between fresh porcine aortic valve leaflet and those fixed at medium or high pressure revealed that the following changes may occur: elimination of the natural collagen crimping, and extensive loss of the endothelial layer. The denaturation temperatures of the glutaraldehyde-fixed leaflets were significantly greater than the genipin-fixed leaflets; however, their fixation indices were comparable. Generally, fixation pressure did not affect the crosslinking characteristics of the genipin- and glutaraldehyde-fixed leaflets. It was found that fixation of porcine aortic valves in genipin or glutaraldehyde did not alter the mechanical anisotropy observed in fresh valve leaflets. This indicated that the intramolecular and intermolecular crosslinks introduced into the collagen fibrils during fixation is of secondary importance to the presence of structural and mechanical anisotropy in fresh leaflet. Tissue fixation in genipin or glutaraldehyde may produce distinct crosslinking structures. However, the difference in crosslinking structure between the genipin- and glutaraldehyde-fixed leaflets did not seem to cause any significant discrepancies in their mechanical properties when compared at the same fixation pressure. Nevertheless, regardless of the crosslinking agent used, changes in mechanical properties and ruptured patterns were observed when the valve leaflets were fixed at distinct pressures.

Changes in serum conditioning profiles of glutaraldehyde-crosslinked collagen sponges after their treatment with calcification inhibitors

The purpose of this study was to evaluate the effects of the calcification inhibitors FeCl3 and sodium dodecyl sulfate (SDS) on the morphology of glutaraldehyde-crosslinked type I collagen sponges and on their serum conditioning. Scanning electron microscopy (SEM) showed that the morphology of the sponges, already modified by glutaraldehyde crosslinking, underwent further changes after treatment of the hydrogels with inhibitors. Coral-like structures were found to branch from the bulk of the material especially in the case of SDS-treated samples. The composition and morphology of the conditioning layers was characterized after 48 h incubation in serum by SDS-polyacrylamide gel electrophoresis-immunoblot of the adsorbed proteins, by energy-dispersive X-ray analysis of the elements (EDX), and by SEM of the conditioned surfaces. All the samples showed the adsorption of proteins with molecular weights ranging from 10 to 203 kD. However, the peculiar adsorption of an approximately 10-kD band (complement C3 fragment) and of fibronectin were detected in the case of glutaraldehyde-crosslinked collagen. On the other hand, glutaraldehyde-crosslinked collagen treated with 0.1M FeCl3 showed the remarkable adsorption of a 29-kD band. The glutaraldehyde-crosslinked hydrogels showed the massive precipitation of crystals on their exposed surfaces, whereas a disordered network structure surrounding the collagen fibrils was found in the case of the samples pretreated with inhibitors. A predominant precipitation of sodium and chloride was detected in all the sponges, although the ratio between the peaks changed from from one hydrogel to another. The results reported in this article clearly indicate that the treatments with SDS and FeCl3 change the surface conditioning of collagen sponges, suggesting a possible role of deposited serum solutes in affecting mineralization processes on bioprosthesis.

Viscoelasticity of dynamically fixed bioprosthetic valves. II. Effect of glutaraldehyde concentration

OBJECTIVE

We have previously shown the benefits of dynamic fixation over conventional static fixation of bioprosthetic valves. In an attempt to increase the durability of bioprosthetic heart valves, we explored the benefit of low-concentration glutaraldehyde dynamic fixation.

METHODS

Pig aortic valves obtained fresh from the abattoir and excised with the entire root were dynamically fixed in glutaraldehyde phosphate buffer solutions varying in concentration from 0.05% to 2.5%. Denaturation temperatures were measured and mechanical testing was performed at low (3 mm/sec) to high physiologic rates (30 mm/sec) at 37 degrees C in isotonic modified Hanks solution.

RESULTS

When fixed dynamically in 0.05% glutaraldehyde solution for 24 hours, the tissue reached a degree of cross-linking (denaturation temperature = 82.8 degrees +/- 0.6 degree C) significantly higher than that obtained for 0.05% static fixation (denaturation temperature = 79.3 degrees +/- 0.9 degree C) (p < 0.05) but similar to that for conventional static fixation in 0.5% glutaraldehyde solution (denaturation temperature = 83.5 degrees +/- 0.3 degree C). After fixation in low-concentration glutaraldehyde (0.05%), final relaxation slopes and moduli in the circumferential direction were significantly higher than those for the statically fixed tissue but similar to those for the fresh tissue. However, both dynamic and static fixation had the effect of increasing tissue extensibility to similar extents in both directions, irrespective of glutaraldehyde concentration.

CONCLUSIONS

Dynamic glutaraldehyde fixation of a porcine aortic valve at lower concentrations resulted in a better degree of cross-linking and a material with biomechanical properties that more closely mimic those of natural heart valve tissue.

Dynamic glutaraldehyde fixation of a porcine aortic valve xenograft. I. Effect of fixation conditions on the final tissue viscoelastic properties

Sixty porcine aortic valves were fixed under dynamic conditions at specific durations, pressures and vibration rates in a 0.5% glutaraldehyde phosphate buffer (pH 7.4, 0.2 M). Tensile relaxation tests were performed at low through high extension rates (0.3, 3 and 30 mm s-1) and tissue denaturation temperatures were determined by the hydrothermal isometric tension method. Conventional statically fixed valves and fresh valves were used as controls. No differences between dynamic and static treatment were observed at pulsation rates above those expected in the physiological range (i.e. above 1.2 Hz) or at higher pressures such as 30 mmHg. However, differences in both stress relaxation rates and denaturation temperatures were delineated in milder fixation conditions, i.e. at low pressures (< 4 mmHg) and low vibration rates similar to that of the normal heart beat (approximately 1.2 Hz). In these conditions the relaxation rate of the dynamically fixed tissue (-7.4 +/- 0.7% of stress remaining per log(s)) was similar to that of the fresh tissue (-6.7 +/- 1.2% log(s-1)) and significantly higher than the statically treated tissue (-3.9 +/- 1.7% log(s-1)). The rates of stress relaxation appeared to be strain rate dependent in both radial and circumferential directions when the tissues were strained at physiological rates during testing (> approximately 15000% min-1). Dynamically treated valves showed higher denaturation temperatures (mean +/- SD) (89.4 +/- 0.5 degree C) compared with the statically fixed (82.7 +/- 1.4 degrees C) or untreated (fresh) valves (65.5 +/- 0.8 degree C). The results suggest a higher degree of internal cross-linking owing possibly to enhanced penetration of the glutaraldehyde reagent and a greater accessability of reactive cross-linking sites on the collagen molecules. Better stress relaxation rates are likely associated with an increase in potential shearing between adjacent collagen fibres thus preserving the natural stress-reducing mechanism of the fresh, untreated valves. The dynamically treated valves therefore possess characteristics that may enable them to better resist long-term mechanical fatigue and in vivo degradation.

Cross-linking of dermal sheep collagen using a water-soluble carbodiimide

A cross-linking method for collagen-based biomaterials was developed using the water-soluble carbodiimide 1-ethyl-3-(3-dimethyl aminopropyl)carbodiimide hydrochloride (EDC). Cross-linking using EDC involves the activation of carboxylic acid groups to give O-acylisourea groups, which form cross-links after reaction with free amine groups. Treatment of dermal sheep collagen (DSC) with EDC (E-DSC) resulted in materials with an increased shrinkage temperature (Ts) and a decreased free amine group content, showing that cross-linking occurred. Addition of N-hydroxysuccinimide to the EDC-containing cross-linking solution (E/N-DSC) increased the rate of cross-linking. Cross-linking increased the Ts of non-cross-linked DSC samples from 56 to 73 degrees C for E-DSC and to 86 degrees C for E/N-DSC samples, respectively. For both cross-linking methods a linear relation between the decrease in free amine group content and the increase in Ts was observed. The tensile strength and the high strain modulus of E/N-DSC samples decreased upon cross-linking from 18 to 15 MPa and from 26 to 16 MPa, respectively. The elongation at break of E/N-DSC increased upon cross-linking from 142 to 180%.

Glutaraldehyde as a fixative in bioprostheses and drug delivery matrices

The use of glutaraldehyde as a fixative in bioprostheses and drug delivery matrices is reviewed. The chemistry of glutaraldehyde cross-linking and its effect on the biological performance of a number of bioprostheses such as tissue heart valves, vascular grafts, pericardial patches, tendon grafts and drug delivery matrices are examined.

Biomechanical and ultrastructural comparison of cryopreservation and a novel cellular extraction of porcine aortic valve leaflets

Heart valve substitutes of biological origin often fail by degenerative mechanisms. Many authors have hypothesized that mechanical fatigue and structural degradation are instrumental to in vivo failure. Since the properties of the structural matrix at implantation may predetermine failure, we have examined the ultrastructure, fracture, mechanics, and uniaxial high-strain-rate viscoelastic properties of: (1) fresh, (2) cryopreserved, and (3) cellular extracted porcine aortic valve leaflets. The cellular extraction process is being developed in order to reduce immunological attack and calcification. Cryopreservation causes cellular disruption and necrotic changes throughout the tissue, whereas extraction removes all cells and lipid membranes. Both processes leave an intact collagen and elastin structural matrix and preserve the high-strain-rate viscoelastic characteristics of the fresh leaflets. Extraction does cause a 20% reduction in the fracture tension and increases tissue extensibility, with the percent strain at fracture rising to 45.3 +/- 4 (mean +/- SEM) from 31.5 +/- 3 for fresh leaflets. However, extraction does preserve matrix structure and mechanics over the physiological loading range. Glutaraldehyde fixation produces increased extensibility, increased elastic behavior, and, when applied to extracted leaflets, it causes a marked drop in fracture tension, to 50% of that for fresh leaflets. The combination of extraction and fixation may lead to early degenerative failure. The cellular extraction technique alone may be a useful alternative to glutaraldehyde fixation in preparing bioprosthetic heart valves.

Biaxial strain analysis of the porcine aortic valve

The function of a bioprosthetic heart valve is determined largely by the material properties of the valve cusps. The mechanics of natural and bioprosthetic valve cusps have been studied extensively using uniaxial tensile testing. This type of testing, however, does not duplicate the natural biaxial loading condition. Whole-valve biaxial testing therefore is preferred. The objective of the present study was to investigate the heterogeneity of the valve cusps by mapping out the regional variability of the biaxial strain versus pressure relationship. Whole porcine aortic valves were mounted horizontally, submerged in physiologic saline solution at 37 degrees C, and pressurized in the range of 0 to 130 mm Hg of pressure. The ventricular side of the cusps were marked with black dots and the three-dimensional position of these dots was recorded together with the aortic pressure. By calculating the distance between the dots in the radial and circumferential directions in different regions, the local strain versus pressure relationship was determined. The results showed that the valve cusp material strained by 23% +/- 0.8% in the radial direction and 10.0% +/- 0.5% in the circumferential direction before lock-up. It was also found that while the valve cusp was highly anisotropic in the central region, the basal region was relatively isotropic, and the cusp as a whole was asymmetrical in its distensibility.

Effect of molecular structure of poly(glycidyl ether) reagents on crosslinking and mechanical properties of bovine pericardial xenograft materials

With the identification of the exacerbating effect of glutaraldehyde on calcification of heart valve materials, there exists a renewed interest in both alternative reagents and the effects of crosslinking on connective tissues. One potentially useful class of reagents are poly(glycidyl ether) compounds. We have examined 5 of these reagents with different molecular sizes and functionalities for their effects on mechanical properties and collagen denaturation (shrinkage) temperature. Samples of bovine pericardium were tested fresh or after 48 h fixation in one of the five compounds for denaturation temperature, stress-strain response, stress relaxation, plastic deformation, and fracture properties. Of the compounds tested, those with intermediate length backbones and 4 or 5 epoxide groups were most effective in producing intrahelical crosslinking and increased denaturation temperature over 48 h. However, in samples examined after 17 months of fixation, all reagents had equivalently increased the denaturation temperature. Examination of mechanical results revealed two distinct mechanisms for mechanical change. Observed shifting of the stress-strain curve to the right (due to shrinkage), increased plastic deformation, and some reduction of stress relaxation are all unrelated to denaturation temperature (and hence to changes in intrahelical crosslinking). An alternate mechanism, perhaps formation of intermolecular crosslinks may be responsible. Intrahelical crosslinking produces only lesser reductions in stress relaxation. Cross-comparison of reagents of differing molecular structure provides a useful tool toward increased understanding of the mechanical consequences of tissue crosslinking.

Anisotropic elasticity and strength of glutaraldehyde fixed bovine pericardium for use in pericardial bioprosthetic valves

Uniaxial tensile tests were performed on glutaraldehyde fixed bovine pericardial strips prepared from chemically modified pericardial samples. These samples originated from an area which demonstrated anisotropic mechanical properties in the native material and which is suitable for the construction of leaflets for pericardial bioprostheses. After glutaraldehyde fixation the tissue had retained its anisotropicity in stiffness and strength in two orthogonal directions. In the range of the functional stresses for a heart valve leaflet (< 1 MPa) the unconstrained fixation regime had modified the initial anisotropic elastic behavior into a more isotropic one. The implications of these findings are that leaflets manufactured from bovine pericardium can be made to resemble, to a degree, the well known anisotropy found in two orthogonal directions in natural human heart valve leaflets, or porcine bioprosthetic heart valve leaflets.

Numerical simulation of leaflet flexure in bioprosthetic valves mounted on rigid and expansile stents

Recent studies suggest that flexural stresses induced during the opening phase may be responsible for much of the mechanical failures of bioprosthetic heart valves. Sharp leaflet bending is promoted by the mounting of valves on rigid stents that do not mimic the systolic expansion of the natural aortic root. We, therefore, hypothesized that flexural stresses could be significantly reduced by incorporating a flexible or expansile supporting stent into the valve design. Using our own non-linear finite element code (INDAP) and the pre- and post-processor modules of a commercial finite element package (PATRAN), we simulated the opening and closing behaviour a trileaflet bovine pericardial valve. The leaflets of this valve were assumed to be of uniform thickness, with a non-linear elastic behaviour adapted from experimentally obtained bending stiffness data. Our simulations have shown that during maximal systolic valve opening, sharp curvatures are induced in the leaflets near their commissural attachment to the supporting stent. These areas of sharp flexure experience compressive stresses of similar magnitude to the tensile stresses induced in the leaflets during valve closure. By incorporating a stent with posts that pivot about their base, such that a 10% expansion at the commissures is realized, we were able to reduce the compressive commissural stressing from 250 to 150 kPa. This was a reduction of 40%. Conversely, a simple pliable stent with stent posts that deflect inward and outward under load did not achieve a significant reduction of compressive stresses. This numerical analysis, therefore, supports the theory that (i) high flexural and compressive stresses exist at sites of sharp leaflet bending and may promote bioprosthetic valve failure, and (ii) that proper design of the supporting stent can significantly reduce such flexural stresses.

Natural preload of aortic valve leaflet components during glutaraldehyde fixation: effects on tissue mechanics

The mechanics of glutaraldehyde-fixed aortic valve leaflets depend largely on the amount of stress present during fixation. Our previous work has suggested that even when the aortic valve is flaccid, the leaflet components are preloaded. We have, therefore, hypothesized that fixing valve leaflets in this naturally preloaded state will affect the function of their components, the fibrosa and the ventricularis. We have compared the elastic response of fibrosa and ventricularis fixed under 'low' and 'zero' tensile and compressive preload by testing 120 of these layers: (i) fresh, (ii) glutaraldehyde-fixed, and (iii) isolated from whole porcine aortic valve leaflets fixed while intact. In both the radial and circumferential directions, the fibrosa from intact-fixed valves was more extensible than the fresh (39.2 vs 29.2% strain to high modulus phase at p < 0.0122, and 12.7 vs 8.1% strain, at p < 0.0003, respectively). The ventricularis from intact-fixed valves, however, was less extensible than when fresh (35.4 vs 63.7% strain, at p < 0.00001 in the radial direction). The fibrosa must have, therefore, been fixed under compression and the ventricularis under tension, when fixed together in the intact aortic valve cusp. The tensile stresses in the intact-fixed ventricularis produced a greater circumferential elastic modulus than in separately fixed tissue (9.62 vs 4.65 MPa, at p < 0.00001), likely through a fibre recruitment process. Compressive stresses in the fibrosa produced a decrease in the elastic modulus both radially and circumferentially (from 3.79 to 2.26 MPa at p < 0.0023, and from 9.55 to 4.65 MPa at p < 0.00001, respectively). Fixing porcine aortic valves at even minimal tensile and compressive preload, such as that which occurs naturally, significantly alters both the extensibility and the elastic modulus of the valve leaflet components.

Micromechanics of the fibrosa and the ventricularis in aortic valve leaflets

The elastic response of aortic valve cusps is a summation of its fibrous components. To investigate the micromechanical function of valve leaflet constituents, we separated the fibrosa and the ventricularis from fresh and glutaraldehyde-fixed leaflets and tested them individually. The ventricularis was stiffer circumferentially than radially (7.41 kPa vs 3.68 kPa, p less than 0.00001) and was more extensible radially (62.7% vs 21.8% strain to high modulus phase, p less than 0.00001). The fibrosa was also stiffer circumferentially than radially (13.02 kPa vs 4.65 kPa, p less than 0.0008), but had uniform extensibility. Glutaraldehyde fixation did not affect the circumferential elastic modulus of the fibrosa, but reduced its radial modulus from 4.65 kPa to 2.32 kPa (p less than 0.0078). The elastic modulus of the ventricularis remained unchanged. Fixation also reduced the extensibility of the ventricularis circumferentially (from 21.8% to 15.2% strain, p less than 0.018), but not radially, and increased the radial extensibility of the fibrosa from 27.7% to 46.1% (p less than 0.0048). These data show that while the ventricularis contains a large amount of elastin, the amount of radially oriented collagen is similar to that of the fibrosa. The fibrosa, by itself, has the same extensibility in both directions (about 23% strain), but can extend much more radially when connected to the rest of the leaflet because it is attached to the ventricularis in a highly folded configuration. The two layers therefore complement each other during aortic valve function, and become detrimentally altered by fixation in glutaraldehyde.

An approach to the optimization of preparation of bioprosthetic heart valves

The stress and strain states of the valve leaflets during fixation with glutaraldehyde affect their final mechanical parameters. Comparative studies of the stress-strain relationships of aortic valve leaflet strips from fresh, statically and dynamically fixed porcine and human valves were made. Static pressures of 5 mmHg, 16 mmHg, and 95 mmHg result in stress-strain relationships which are in a region between that of fresh porcine and fresh human leaflet strips in the circumferential direction, while they are far from that of fresh porcine tissue (larger strains) in the radial direction. Leaflet strips, fixed under dynamic loading between zero and a predefined maximum load, set at an early post-transition state, give parameters not significantly different from those of human valves.

Effect of alternative crosslinking methods on the low strain rate viscoelastic properties of bovine pericardial bioprosthetic material

Early failures of bovine pericardial heart valves have been due to leaflet perforation/tearing and calcification. Since glutaraldehyde fixation has been shown to produce marked changes in leaflet mechanics and has been linked to the development of calcification, alternative crosslinking techniques have been suggested as means to overcome these obstacles. We have examined the low strain rate viscoelastic behavior of bovine pericardium: (1) fresh; (2) chemically treated with glutaraldehyde, cyanimide, or polyglycidyl ether; or (3) physically treated by freeze-drying or heat-drying. Shrinkage temperature tests were conducted to assess intrahelical crosslinking. Polyglycidyl ether and glutaraldehyde both produced substantial crosslinking, with the shrinkage temperature rising above 80 degrees C. Mechanical changes were nearly equivalent, both showing decreased stress relaxation and increased extensibility consistent with intrahelical crosslinking and shrinkage during fixation. Cyanimide, known to crosslink pure collagen materials, showed no evidence of crosslinking intact tissue. Heat-drying, also effective in pure collagen preparations, produced an increase in UTS and tissue modulus, but otherwise left the tissue unchanged. Freeze-drying had no mechanical effect, and therefore provides an attractive means for the storage of connective tissues for later mechanical testing.

Pulsed CO2 laser ablation of tissue: effect of mechanical properties

The ablation rate of guinea pig skin and bovine aorta, myocardium, and liver by a CO2 laser emitting 2-microseconds-long pulses was quantified. Ablation efficiency was found to be strongly dependent upon the ultimate tensile strength of the tissue; the ablation efficiency of liver is seven times that of skin. Gluteraldehyde cross linking of skin, which is known to greatly increase tissue stiffness but not significantly affect ultimate tensile strength, did not change the ablation rate. The water content of the tissues, which largely determines the optical and thermal properties, was measured and found to vary only slightly. The results demonstrate that tissue mechanical properties are important in the interpretation and modeling of pulsed laser ablation of tissue and that variations in these mechanical properties can lead to drastically different cutting rates for different tissues.

The bovine pericardial xenograft: III. Effect of uniaxial and sequential biaxial stress during fixation on the tensile viscoelastic properties of bovine pericardium

Our previous two articles have shown that glutaraldehyde-fixed bovine pericardium is nearly isotropic, whether fixed without constraints, with tethering, or with pressure. In this study, we have used uniaxial stress during fixation to produce bovine pericardial material with marked tensile anisotropy. Rectangular and cruciate pericardial samples have been mechanically examined after one of four treatments: (i) fixation under 88-kPa uniaxial stress, (ii) fixation under 176-kPa uniaxial stress, (iii) 3 h of 176-kPa uniaxial stress in saline followed by 24-h fixation under the same stress, (iv) fixation under 176-kPa uniaxial stress followed by a second fixation under 176-kPa stress in a direction normal to the first. Strips of material were cut at 0 degree, 30 degrees, 60 degrees, and 90 degrees to direction of the initial stress, and tested for response to cyclic loading, stress relaxation, plastic deformation, and fracture properties. Fixation under uniaxial stress produced anistropy similar to that seen in porcine aortic valve leaflets; however, the overall extensibility of the material depended on the applied stress and the aspect ratio of the stressed sample. While loading in saline produced no change, the sequential biaxial stressing produced a reduction in anisotropy, suggesting exposure of additional crosslinking sites. Uniaxial stress during fixation may be a useful method for construction of anisotropic heart valve leaflets.

The bovine pericardial xenograft: I. Effect of fixation in aldehydes without constraint on the tensile viscoelastic properties of bovine pericardium

Tensile testing of tissue strips has been used to examine the effect of simple fixation in glutaraldehyde and formaldehyde on the viscoelastic properties of bovine pericardium. To assess tissue anisotropy, tissue strips were cut at 0 degree, 30 degrees, 60 degrees, and 90 degrees relative to the base-to-apex direction. Fresh anterior pericardium was modestly anisotropic, being least extensible in the base-to-apex direction; however, fixation removed this anisotropy. Fixation also produced a marked change in the response of the material to initial cyclic loading during preconditioning. Overall extensibility of the fixed material was significantly greater than that for the fresh tissue, consistent with a 10.7% shrinkage in aldehydes calculated from strain at fracture data. Reductions in stress relaxation and creep after fixation were noted as well, consistent with intrafibrillar crosslinking. Cyclic hysteresis and ultimate tensile strength were unaffected. Since the observed changes in the stress-strain response were largely attributable to shrinkage, control of shrinkage by physical means would allow for engineering modification of bovine pericardial mechanics for controlled anisotropy.